n 


609 
U6 

Public 
'  Health 


UC-NRLF 

B    3    T30    2^3 


Y  LIBKAHY 


U.  S.  DEPARTMENT  OF  LABOR 

JAMES  J.  DAVIS.  Secretary 

CHILDREN'S  BUREAU 

GRACE  ABBOTT.  Chief 


PHYSICAL  STATUS 
OF  PRESCHOOL  CHILDREN 

GARY.  IND. 

BY 
ANNA  E.)RUDE.  M.  D. 


^ 


Bureau  Publication  No.  1 1 1 


V\  mm  i[' 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1922 


U.  S.  DEPARTMENT  OF  LABOR 

JAMES  J.  DAVIS.  Secretary 

CHILDREN'S  BUREAU 


GRACE  ABBOTT.  Chief 


PHYSICAL  STATUS 
OF  PRESCHOOL  CHILDREN 

GARY,  IND. 


BY 


ANNA  E.  RUDE.  M.  D. 


•55 


Bureau  Publication  No.   1 1 1 


WASHINGTON 

GOVERNMENT  PRINTING  OFHCE 

1922 


/\ 


CONTENTS. 

Page. 

Letter  of  transmittal 9 

Introduction 11-13 

Scope  of  study 12 

Staff 12 

Methods  and  standards  used 13-26 

General  method  of  conducting  examinations 14 

Physical  examination  record  form  used 15 

Instructions  accompanying  physical  examination  schedule 18 

Measuring  and  weighing 21-23 

Height '...  21 

Weight 22 

Vision  testing 23 

Hearing  testing 24 

Indications  for  recommending  removal  of  tonsils  and  adenoids 25 

Physical  findings 27-62 

Introduction 27 

Findings  in  general 28 

Height  and  weight 32 

Nutrition 36 

Anemia 39 

Vaccination 40 

Head 41 

Eyes 42 

Ears 44 

Mouth 44-45 

Teeth 44 

Other  mouth  defects 45 

Nasopharynx 45-62 

Adenoids 46 

Symptoms  suggesting  adenoids 47 

Tonsils 48 

Lymph  glands 51 

Lungs 55 

Heart 55 

Skin 55 

Abdomen 56 

Bony  and  muscular  systems 57-61 

Bony  defects  of  rachitic  origin 58 

Postural  defects 59 

Arch  measurements 60 

Nervous  system 61 

Mental  condition 62 

Genitalia 62 

500585  ' 


4  CONTENTS, 

Page. 

Appendixes 63-83 

Appendix  A. — General  tables  on  ph.ysical  findings  of  the  preschool  child. .  65 
Appendix  I>.  —Results  of    physical    examinations    of    children    under  '1 

years  of  age 75-83 

Source  of  material 75 

Findings  in  general 75 

Height  and  weight 77 

Nutrition 77 

Anemia 78 

Vaccination 78 

Head 78 

Eyes 78 

Ears 79 

Mouth 79 

Nasopharynx 79-80 

Tonsils 80 

Adenoids 80 

(xlands 80 

Heart 81 

Lungs 81 

Skin 81 

Abdomen 81 

Bony  and  muscular  system 82 

Arch  measurements 83 

Mental  condition 83 

Genitalia 83 


TEXT  TABLES. 

Page. 
Table       I.    Age  and  sex;  children  from  2  to  7  years  of  age  given  physical 

examination 27 

II.    Prevalence  of  defects,  by  sex;  children  2  to  7  years  of  age 

given  physical  examination 28 

III.    Number  of  defects,  by  age  and  sex;  children  2  to  7  years  of 

age  given  physical  examination 30 

IV.   Average  heights  and  weights,  by  sex  and  age;  white  children 

7  years  of  age  and  under  given  physical  examination 36 

V.    Grade  of  nutrition,  by  age  and  sex ;  children  2  to  7  years  of  age 

given  physical  examination 38 

VI.    Grade  of  nutrition,    by   color  and   nationality   of  mother; 

children  2  to  7  years  of  age  given  physical  examination 39 

VII.    Grade  of  nutrition,  by  earnings  of  chief  breadwinner;  children 

2  to  7  years  of  age  given  physical  examination 39 

VIII.   Vaccination,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination 40 

IX.    Vaccination,  time  of  vaccination,  and  entrance  in  school,  by 
color  and  nationality  of  mother ;  children  2  to  7  years  of  age 

given  physical  examination 41 

X.    Defect  of  \asion,  by  age;  children  2  to  7  years  of  age  given 

physical  examination 42 

XI.    Vision,  by  sex  and  eye  disease  or  other  defect;  children  2  to  7 

years  of  age  given  physical  examination 43 

XII.  Eye  disease  or  defect  other  than  of  vision,  by  color  and  nation- 
ality of  mother;  children  2  to  7  years  of  age  given  physical 
examination 43 

XIII.  Decayed  teeth,  by  age  and  sex;  children  2  to  7  years  of  age 

given  physical  examination 44 

XIV.  Naso-pharyngeal  defect,  by  age  and  sex;  children  2  to  7  years 

of  age  given  physical  examination 45 

XV.    Adenoid  condition,  by  age  and  sex;  children  2  to  7  years  of 

age  given  physical  examination 46 

XVI.    Condition  of  tonsils,  by  age  and  sex;  children  2  to  7  years  of 

age  given  physical  examination 49 

XVII.    Prevalence  of  diseased  tonsils,  by  presence  of  decayed  teeth; 

children  2  to  7  years  of  age  given  physical  examination 51 

XVIII.    Condition  of  glands,  by  age  and  sex;  children  2  to  7  years  of 

age  given  physical  examination 52 

XIX.    Condition  of  cervical  glands,  by  condition  of  tonsils  and  teeth; 

children  2  to  7  years  of  age  given  physical  examination 53 

XX.    Condition  of  glands,   by  color  and  nationality  of  mother; 

children  2  to  7  years  of  age  given  physical  examination 54 

XXT.    Distended  abdomen,  by  age  and  sex;  children  2  to  7  years 

of  age  given  physical  examination 56 

XXII.    Defect  of  bony  and  muscular  system,  by  age  and  sex;  children 

2  to  7  years  of  age  given  physical  examination 57 

XXIII.    Postural  defects,  by  age  and  sex;  children  2  to  7  years  of  age 

given  physical  examination 60 

5 


6  PHYSICAL    STATUS    OF    PRESCHOOI.    (   HII.DREN. 

APPENDIX    TABLES. 

Page. 

Appendix  A — General  tables 65-73 

Tablk  1 .  Prevalence  of  defects,  by  sex;  children  2  to  7  years  of  age  given 

j)hysical  examination 65 

2.  Specified  defects,  by  age  and  sex;  children  2  to  7  years  of  age 

given  physical  examination 65 

3.  Specified  defects,  by  color  and  nationality  of  mother;  children 

2  to  7  years  of  age  given  physical  examination 67 

4.  Specified  defects,  by  earnings  of  chief  bread \vinner;  children 

2  to  7  years  of  age  given  physical  examination 67 

5.  Per  cent  of  children  ^\'ith  specified  defects,  by  deviation  from 

average  weight  for  height;  children  2  to  7  years  of  age  given 
physical  examination 67 

6.  Specified  skin  diseases,  by  age  and  sex ;  children  2  to  7  years  of 

age  given  physical  examination 68 

7.  Condition  of  specified  glands,  by  sex;  children  2  to  7  years  of 

age  given  physical  examination 69 

8.  Specified  defects  of  bony  and  muscular  system,  by  age  and  sex; 

children  2  to  7  years  of  age  given  physical  examination 70 

9.  Relation  of  weight  to  height,  by  age  and  sex;  children  2  to  7 

years  of  age  given  physical  examination 70 

10.  Relation    of  weight  to   height,    by  color  and  nationality  of 

mother;  children  2  to  7  years  of  age  given  physical  exami- 
nation           71 

11.  Prevalence  of  specified   defects,  by  deviation  from  a^'erage 

weight  for  height;  children  2  to  7  years  of  age  given  physical 
examination 72 

12.  Annual  earnings  of  chief  breadwinner,  by  color  and  nativity 

of  mother;   children  2  to  7  years  of  age  given  physical  ex- 
amination           73 

Appendix  B: 

Table  I.  Number  of  defects,  by  age  and  sex;  children  under  2  years 

of  age  given  physical  examination 75 

II.  Prevalence  of  disease  or  defects,  by  sex;  children  under  2" 

years  of  age  given  physical  examination 76 

III.  Grade  of  nutrition,  by  age  and  sex;  children  under  2  years 

of  age  given  physical  examination 77 

IV.  De\dation  from  average  weight  for  height,  by  age  and  sex; 

children  under  2  years  of  age  given  physical  examination . .         78 
V.  Nasopharyngeal  defects,  by  age  and  sex;  children  under  2 

years  of  age  given  physical  examination 79 

VI.  Condition  of  tonsils,  by  age;  children  under  2  years  of  age 

given  physical  examination 80 

VII.  Condition   of  glands,  by   age  and  sex;  children   under   2 

years  of  age  given  physical  examination 81 

VIII.  Rickets,  by  age  and  sex;    children  under  2  years  of  age 

given  physical  examination 82 

IX.  Rickets,  by  condition  of  tonsils;  children  under  2  years  of 

age  given  physical  examination 82 

X.  Condition  of  glands,  by  presence  of  rickets;  children  under 

2  years  of  age  given  physical  examination S3 

XI.  Comparison  of  the  prevalence  of  defects  in  children  under 
2  years  of  age  and  children  2  to  7  years  of  age  given  phy- 
sical examination 83 


ILLUSTEATIONS.  7 

CHARTS. 

L  Page. 

f     Chart       I.    Average  heights  of  boys  from  birth  to  six  years  of  age;  Children's 
Year,   Gary,   (iary  and    Health   Conferences    combined,    and 

Crum 32 

II.  Average  heights  of  girls  from  birth  to  six  years  of  age;  Children's 
Year,  Gary,  Gary  and  Health  Conferences  comlnned,  and 
Crum \ 33 

III.  Average  weights  of  boys  from  l)irth  to  six  years  of  age;  Children's 

Year,   Gary,   Gary  and    Health    Conferences    combined,   and 
Crum 34 

IV.  Average  weights  of  girls  from  birth  to  six  years  of  age;  Children's 

Year,   Gary,   Gary  and    Health    Conferences    combined,   and 

Crum 35 

V.    Per  cent  of  children  having  one  or  more  defects,  from  birth  to  six 

years  of  age 84 


ILLUSTRATIONS. 

Page. 

Measuring Faces  22 

Measuring  square Faces  22 

Measuring  strip Faces  22 

Weighing  in  scoop  scale Follows  22 

Weighing  on  beam  scale Follows  22 

Vision  testing Faces  23 

Healing  testing Faces  23 


LETTER  OF  TRANSMITTAL. 


U.  S.  Department  of  Labor, 

Children's  Bureau, 

WasUngton,  April  29,  1922. 
Sir  :  There  is  transmitted  herewith  a  report  on  the  Physical  Status 
of  Preschool  Children,  Gary,  Ind.,  by  Dr.  Anna  E.  Rude,  director  of 
the  child  hygiene  division  of  the  Children's  Bureau.  The  investiga- 
tion on  which  the  report  is  based  was  planned  by  Dr.  Grace  Meigs 
Crowder,  formerly  director  of  the  child  hygiene  division  of  the  bureau. 
All  the  field  work  of  the  investigation  was  in  charge  of  Doctor  Rude, 
and  the  material  has  been  organized  by  her  with  the  assistance  of 
Caroline  Legg. 

Respectfully  submitted. 

Grace  Abbott,  Chief. 
Hon.  James  J.  Davis, 

Secretary  of  Labor. 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN, 

GARY,   IND. 


INTRODUCTION. 

In  coimection  with  the  social  and  economic  study  of  infant  mor- 
tality and  the  preschool  child  in  Gary,  Ind.,  made  in  1918  by  the 
United  States  Children's  Bureau,  an  investigation  to  determine  the 
physical  condition  of  the  children  was  conducted  by  the  hygiene 
division  of  the  bureau.  In  all,  4,348  individual  examinations  of 
children  under  7  years  of  age  were  made  during  the  six-month  period 
extending  from  April  to  October. 

The  splendid  interest  and  hearty  cooperation  of  the  Gary  school 
authorities  made  possible  the  systematic  examination  of  practically 
all  children  under  7  years  of  age  who  were  attending  the  kindergartens 
and  primary  grades  in  all  the  public  schools  and  in  three  parochial 
schools. 

The  school  examinations  occupied  the  first  three  months  of  the 
investigation,  following  which  the  examinations  were  conducted  in 
cliildren's  health  conferences.  The  first  conference  center  was  in  a 
vacant  store  in  the  center  of  the  business  district  on  the  North  Side 
of  Gary.  The  conference  rooms  were  open  from  9  o'clock  in  the 
morning  until  4.30  o'clock  in  the  afternoon  every  day  except  Satur- 
day and  Sunday.  Children  were  examined  by  appointment  onl3^ 
The  second  conference  or  consultation  center  was  opened  for  the  last 
two  months  of  the  study  on  the  South  Side  of  the  city,  where  a  large 
proportion  of  the  foreign  population  lived. 

In  order  to  stimulate  interest  in  the  health  conferences  and  instruct 
the  public  as  to  their  general  purpose,  the  cooperation  of  the  Gary 
Cliildren's  Year  Committee  of  the  Council  of  National  Defense  was 
enlisted.  This  committee  secured  active  interest  and  cooperation 
from  the  mayor,  the  women's  organizations,  the  men's  clubs,  and  the 
school  authorities,  and  conducted  a  poster  contest  on  the  subject 
of  child  care  in  the  Gary  schools.  Two  men's  organizations,  the 
commercial  club  and  the  chamber  of  commerce,  donated  $75  for 
prizes  in  the  form  of  thrift  and  war-savings  stamps. 

An  exhibition  of  posters  from  all  the  school  grades  in  a  do\\Ti-to\\Ti 
shop  window,  prior  to  the  awarding  of  the  prizes,  helped  to  arouse 

11 


12  PHYSTCAIi  STATUS -OF   PRESCHOOL  CHILDREN. 

interest' and  attract  attention  to  the  forthcoming  conferences,  where  a 
large  collection  of  posters  was  finally  displayed. 

Another  feature  of  the  conferences  which  attracted  considerable 
attention  was  the  exhibit  of  small  models  which  included  a  bed 
properly  prepared  for  a  mother  at  confinement,  baskets  and  cribs  for 
the  baby,  the  necessary  bath  equipment,  utensils  for  preparing  food 
and  Pasteurizing  milk,  an  iceless  refrigerator,  play  pens,  simple  and 
cheap  homemade  screens,  etc.  There  were  also  models  of  infants' 
clothes,  and  paper  patterns  from  which  the  mothers  might  cut  dupli- 
cates if  they  so  desired.  Simple  meals  for  the  preschool  child  were 
shown  in  a  glass  case,  and  the  values  of  pai'ticular  kinds  of  food  were 
explained  by  a  nurse.  Children's  Bureau  publications  dealing  with 
prenatal  care  and  the  care  of  infants  and  young  children  were  dis- 
played, and  given  free  to  persons  desiring  them.  Much  interest  was 
evinced  in  these  exhibits,  and  in  the  wall  charts  which  pictured 
various    phases    of    child   care   with   warnings    and   suggestions   to 

mothers. 

SCOPE   OF   STUDY. 

Tabulations  were  made  of  the  records  of  3,125  children  whose  ages 

ranged  from  2  to  7  years  ,^  and  of  994  infants  under  2  years  of  age. 

The  data  relating  to  the  latter  are  presented  in  Appendix  B,  but  the 

descriptions  of  methods  include  those  used  in  the  examinations  both 

of  infants  and  of  older  children.     In  both  age  groups  the  distribution 

by  sex  was  fairly  even.     The  older  group  included   1,555  boys  and 

1,570  girls.     It  was  possible  to  make  certain  correlations  for  this  group 

with  items  on  the  family  schedules  which  were  taken  for  all  of  these 

children  in  the  general  study  of  children  of  preschool  age  made  by 

the  Children's  Bureau.^ 

STAFF. 

The  regular  working  staff  consisted  of  three  physicians,  two  nurses, 
and  four  clerical  assistants. 

A  specialist  from  Chicago  was  engaged  for  one  day  a  week  to 
examine  all  children  who  had  been  found  upon  examination  to  have 
eye,  ear,  nose,  or  throat  defects.  These  special  examinations  were 
discontinued  after  the  conferences  were  begun,  owing  to  the  fact  that 
the  majority  of  the  examinations  in  the  conferences  were  of  infants 
and  the  comparative  infrequency  of  these  defects  in  infancy  made  the 
services  of  the  specialist  seem  unwarranted. 

During  the  examinations  in  the  schools,  the  school  nurses  were 
loaned  to  the  Children's  Bureau  staff  for  almost  full-time  assistance. 

1  Included  in  this  group  were  220  cliildren  who  had  passed  their  seventh  birthdays  between  the  date 
of  beginning  the  study  and  the  date  of  the  physical  examination.  Since  the  majorit  y  of  these  220  children 
were  stiUless  than  7h  years  of  age,  and  since  data  concerning  them  apjjeared  in  the  family  schedules  wliich 
had  been  taken  and  had  already  been  incorporated  in  other  reports  on  the  Gary  investigation,  tliey  have 
been  included  in  all  discussions  where  ages  are  not  distinguished;  but  where  ages  are  distinguished  this 
group  is  not  separately  discussed. 

2  Children  of  Preschool  Age  in  Garj',  Ind.    (In  press.) 


METHODS    AND   STANDAKDS    USED.  13 

They  determined  from  the  school  register  what  children  were  eUgible 
for  examination,  notified  parents  as  to  date  and  time  of  examination, 
invited  them  to  be  present,  and  brought  the  chiklren  in  turn  to  the 
examination  room.  The  interest  of  the  parents  was  most  encourag- 
ing; in  several  of  the  school  districts  approximately  75  per  cent  of  the 
mothers  were  present  for  the  examinations.  The  nurses  also  helped 
with  the  undressing  and  dressing  processes..  During  the  entire  study 
they  rendered  valuable  assistance  by  following  up  cases  reported  by 
the  physicians  as  in  need  of  special  attention.  One  nurse  acted  as 
interpreter,  such  service  being  indispensable  during  the  conference 
on  the  South  Side  of  Gary,  where  the  families  of  the  foreign-bom 
predominated.  A  list  of  the  defects  noted  upon  examination  was 
transcribed  on  the  school  physical  examination  card  for  a  permanent 
school  record,  a  duplicate  of  which  was  sent  by  the  school  authorities 
to  the  parents. 

METHODS  AND   STANDARDS   USED. 

The  chief  value  of  this  report  on  the  physical  condition  of  the 
preschool  child  in  a  typical  industrial  center  lies,  perhaps,  not  so 
much  in  the  data  gathered  as  in  the  presentation  of  the  methods  and 
standards  used  in  the  study.  The  dearth  of  definite  information 
regarding  the  physical  condition  of  the  preschool  child  is  noteworthy; 
the  data  obtained  in  this  investigation  are  offered  as  the  result  of 
uniformly  careful  examinations.  The  usual  lack  of  uniformit}^  in 
methods  of  examination,  record  forms,  etc.,  makes  for  apparent 
unreliability  in  data,  and  this  has  a  tendency  to  lower  rather  than  to 
raise  standards.  It  is  doubtful  if  any  physical  examination  record 
form  or  method  of  examination  would  meet  with  universal  approval. 
The  methods  and  standards  used  in  this  study  are  not  offered  as 
ideal;  but  since  there  is  a  generally  recognized  need  for  standardiza- 
tion in  all  phases  of  child-welfare  work,  the  plan  has  been  given  in 
detail  in  the  hope  that  the  report  may  serve  to  some  extent  as  a 
handbook  for  similar  scientific  investigations  as  well  as  for  the  less 
technical  popular  health  activities  of  both  private  and  Governmental 
organizations. 

In  order  that  data  gathered  in  this  study  might  conform  to  the 
standard  of  exactness  required  in  making  statistical  tabulations,  it 
was  necessary  to  plan  definite  standards  for  recording  observations. 
The  difficulties  involved  are  readily  recognizable,  since  much  of  the 
information  secured  through  ordinary  physical  examinations  shows 
variation,  according  to  the  individual  examiner's  judgment.  While 
such  data  may  be  sufficiently  accurate  for  clinical  purposes,  they  do 
not  have  the  degree  of  conciseness  and  uniformity  necessary  for 
statistical  tabulations. 


14  PHYSICAL,   STATUS   OF   PRESCHOOL   CHILDREX. 

GENERAL   METHOD   OF   CONDUCTING   EXAMINATIONS. 

The  following  general  procedure  was  adhered  to  almost  mthout 
exception  throughout  the  six  months  devoted  to  the  physical  examina- 
tions recorded  in  this  study. 

The  child  was  first  given  the  vision  and  hearing  tests,  in  a  room 
speciall}^  set  aside  for  the  purpose.  This  was  done  first  in  order  to 
eliminate  the  possibility  of  any  nervous  strain  after  subjection  to 
the  physical  examination.  It  was  most  important  in  testing  eyes  and 
ears  to  gain  the  child's  undivided  attention,  for  if  it  was  at  all  strained 
or  unnatural  the  results  were  necessarily  less  accurate.  Moreover,  by 
subjecting  him  at  the  start  to  an  active  rather  than  a  passive  examina- 
tion, i.  e.,  to  one  in  which  his  own  faculties  were  exercised,  the  child's 
cooperation  and  confidence  were  secured  for  the  more  trying  ordeal 
of  a  complete  physical  examination.  The  details  of  the  ^dsion  and 
hearing  tests  and  the  method  of  grading  will  be  described  subse- 
quentl}^.^ 

After  the  tests  of  sight  and  hearing  were  completed  the  child  was 
directed  to  a  dressing  room  and  completely  undressed  by  a  nurse  or 
parent;  separate  rooms  were  provided  for  boys  and  girls.  As  soon 
as  the  clothing  was  removed  the  child's  body  was  covered  with  a 
clean  square  of  flannelette  fastened  around  the  trunk  and  falling  to 
the  knees,  and  the  height  and  weight  were  taken.  This  was  done 
either  at  one  end  of  the  large  room  in  which  the  examinations  were 
made  or  in  a  smaller  separate  room,  according  to  available  facilities. 
After  the  record  of  height  and  weight  was  made  the  child  was  ready 
for  the  doctor. 

The  physical  examination  was  strictly  private,  each  physician 
having  a  curtained  booth  about  8  by  10  feet.  The  examining  table 
was  covered  with  a  clean  white  sheet  and  provided  with  all  necessary 
equipment  for  making  a  thorough  physical  test,  including  stethoscope, 
thermometer,  tongue  blades,  culture  tubes  and  slides,  standard  tape 
measures  and  rulers,  paper  towels,  facilities  for  sterilizing  instruments, 
and  celluloid  toys  which  were  used  to  divert  the  attention  of  ^^ounger 
children  during  the  more  trying  parts  of  the  examination.  A  clerical 
assistant  at  one  end  of  the  table  recorded  the  details  of  the  examina- 
tion as  dictated  by  the  doctor,  and  noted  such  facts  as  date  of  birth, 
age  at  entering  school,  grade  attained,  and  history  of  previous  ill- 
nesses. 

A  record  of  height  and  weight,  vision  and  hearing  grades,  and 
defects  found,  if  any,  together  with  suggestions  concerning  their 
correction  and  dietary  advice  applicable  to  the  individual  child, 
were  given  to  the  mother  before  she  left  the  conference  rooms. 

3  See  pp.  23  and  24. 


METHODS   AXD   STANDARDS    USED.  15 

PHYSICAL   EXAMINATION   RECORD   FORM   USED. 

A  physical  examination  record  form  was  prepared  from  which 
statistical  data  could  easily  be  transcribed.  Wliile  to  the  average 
physician  this  form  may  appear  unnecessarily  detailed  for  practical 
use,  experience  has  shown  that  the  system  of  establishing  uniform 
standards  and  then  requiring  every  item  to  be  checked  is  probabl}^ 
the  only  means  of  insuring  sufficiently  accurate  and  detailed  informa- 
tion in  routine  physical  examinations. 

The  practicability  of  this  particular  record  form  has  been  tested 
by  use  both  in  this  study  and  in  subsequent  work.  Some  of  the  items 
could  well  be  omitted,  and  the  form  could  be  made  practical  for 
continued  use  only  by  providing  space  for  the  records  of  repeated 
examinations  on  the  reverse  side  of  the  card.  The  general  arrange- 
ment, however,  has  proved  satisfactory  and  practical  from  a  statis- 
tical standpoint. 


16 


PHYSlC-y:.  STATUS  OF  PRESCHOOL   CHILDREN. 


CQ 


5i 


o 

CO 

o 

!Z 

OS 
< 

Q 

CO 


W      CO 


6   Zm   5 

.>  CO    •    •  <<    •  m    • 


^^      S      1 


C-3 


^•z    ;?; 


(M  S  =n  i       = 


^^       ^ 


.2 -csa.. 

^  /I,  a;  Qj  2  ^  ^ 

uo  a) -3  —  ^  c 
. .  C  0^  (i   -■c 

S  ?^  C  "e  a3  ^ 


CO 


T}i      10     *5l  id  I 


5"c 


«    ;::^    (1, 


•^        £  5:  O  s^ 

!i^  03  s:  p  ^^  ^ 

.     .     .  W<2. 


5C  t-^ : 


E-g§g"-35-S 
g|ZH^OQ 

h^        Cl  ■*        IC  CO 
<*        C^  C^        COM 


ZZ222ZZ 


zzzzzzz 


zzzzzzz 

J^  ^  ^  ,1^  ^  ^  ^ 


2ZZZZZZ 

1^  pn  j^  pH  pH  JH  ^ 


w  03  C3  t;  S^  2 

•~  5  'S  =^  -S  t:  a> 


•     x  s  t  .^ 

Z       C3  §'5^';3  , 


1-    8    •; 


^■!z 

"is 
^■§.3 

la  c3  o_ 


:fz5 


S"iSg    z 

g  ..Z    :-  ..22 

g  2  M^  S  >. 

_r !-  -  03  ~^  t. 


p3-p^rsr";r 


Wg 


cp; 


3Z". 

-T3  ?* 


9  —  ""  is  &•< 


fe       t:^ 


^  .2 


>  c  £--  o 
0    ffiSZ| 

•  ^  u  oi  3 
'^u       .   . 


■7-  « 


o  0)  3 


Hal 


•a&.^ 


C3 


O  3 


p.  a;" 
os.o'ots'S' 


Z 

3  S      i  ^ 


z-s 

a  03 


m  03 
t-i  a) 


fiji  d      Z 
«-.  E-l  c  R  S 


5  2  2S.5-'5 


[KHOJ   QHOOaH   NOIXVNIKVXa   IVDISAHJ] 


METHODS   AND   STANDARDS   USED.  1? 


[record    form — REVERSE.] 

Genitalia:  79.  Male:  pre])uce  adherent,  contracted,  normal. 
80.  Female:  vaginal  discharge,  N. 

Mental  Condition:  81.  (a)  Normal,  N.  (b)  Defect  app.  (spec). 
(c)  Abnormality  susp.  (spec.) 

82.  Laboratory  Findings: 

83.  Previous  Illness:  (a)  Contagious; 

(b)  Respiratory: 

(c)  Digestive: 

(d)  Other: 

84.  Bad  Habits: 

85.  Summary  of  Defects  and  Diseases: 

86.  Recommendations: 

108178°— 22 2 


18  PHYSICAL   STATUS   OF    PRESCHOOL    CHILDRE^^T. 

INSTRUCTIONS   ACCOMPANYING   PHYSICAL   EXAMINATION    SCHEDULE. 

Every  question  on  the  schedule  must  be  checked.  If  abnormal, 
check  this  word  or  the  condition  listed;  if  normal,  check  N,  meaning 
"No"  or  not  abnormal.  Care  should  be  taken  that  the  check  is  in 
the  letter  or  word  intended.  Carelessness  in  checking  means  inac- 
curacy in  tabulations,  and  schedules  with  omissions  deplete  the  total 
base  or  are  thrown  out. 

General. 

(5)"  WEIGHT.     To  be  taken  without  clothes. 

(6)  HEIGHT.     To  be  taken  without  shoes. 

Measuring  board  to  be  brought  down  until  horizontal  part  just 
touches  child's  head  firmly  while  perpendicular  part  is  pressed 
against  the  wall.  Most  mistakes  are  made  in  reading;  therefore 
measurements  to  be  taken  twice,  once  before  and  once  after  exami- 
nation, and  entry  made  on  record  after  the  second  measurement. 

(7)  ANEMIA.  To  be  determined  by  inspection  of  color  of  mucous 
membranes,  especially  conjunctivae. 

(8)  NUTRITION.^  "Excellent"  indicates  a  condition  superior 
to  "good."  "Good"  is  to  be  checked  if  the  child's  weight  is  within 
a  10  per  cent  deviation  below  average  weight  for  height.  "Poor" 
to  be  checked  when  weight  is  below  10  per  cent  deviation  from  average 
weight  for  height  and  when  supervision  is  required.  "Very  poor" 
to  be  checked  where  weight  is  more  than  10  per  cent  below  average 
weight  for  height  and  medical  treatment  is  required.  "Poor"  or 
"very  poor"  is  always  to  be  noted  under  Summary  and  Recom- 
mendations. 

(9)  TEMPERATURE.    To  be  taken  onlv  if  symptoms  indicate. 

(10)  VACCINATED.  Unless  the  mothei-  is  with  the  child  it  may 
not  be  possible  to  ascertain  the  age  at  which  he  was  vaccinated  for 
smallpox,  but  it  may  be  learned  from  the  teacher  whether  or  not  it 
was  done  before  he  entered  school. 

Head. 

(11)  SIZE.  If  abnormal,  the  fronto-occipital  circumference  is  to 
be  measured  wnth  tape  and  the  measurement  recorded. 

(12)  SHAPE.  If  abnormal,  "square  head,"  "hydrocephalic," 
"oxycephalic,"  or  " scaphocephalic "  may  be  specified. 

(13)  ABNORMAL  CONDITION.  Here  may  be  noted  abnormal 
conditions  of  scalp,  features,  hair,  etc. 

Eyes. 

(17)  VISION.  To  be  tested  by  one  person,  using  "illiterate" 
chart."  All  cases  of  defective  vision  to  be  listed  and  referred  for  con- 
sultation with  specialist. 

(20)  OTHER  ABNORMALITIES.  Such  conditions  as  nystag- 
mus, etc.,  to  be  noted  here  and  every  case  to  be  listed  for  consultation 
with  the  specialist. 

*  Figures  refer  to  items  on  record  form. 

6  See  page  36. 

6  For  details  of  vision  testing,  see  page  23. 


methods  and  standards  used.  19 

Ears. 

(22)  HEARING.  To  be  tested  by  one  person,  using  ''whispered 
voice. "^  If  hearing  is  defective  or  there  is  any  discharge,  the  chikl 
is  to  be  listed  and  referred  to  the  specialist  for  examination  for  ceru- 
men, retracted  drums,  and  adenoids. 

Mouth. 

(27)  MALOCCLUSION.  Includes  any  condition  causing  an 
abnormal  bite. 

(29)  OTHER  ABNORMAI^ITIES.  Here  should  be  noted  general 
conditions  of  cleanliness  and  types  of  teeth,  such  as  syphilitic,  rachitic, 
and  those  devoid  of  enamel,  abnormal  condition  of  gums  and  mucous 
membranes,  badly  coated  tongue,  offensive  breath,  etc. 

Nasopharynx. 

Children  with  colds  are  to  be  excluded  from  examination  until  well. 

(30)  MOUTH  BREATHING.  To  be  tested  by  closing  the  mouth 
to  see  if  child  breathes  easilv  through  nostrils. 

(32)  NASAL  OBSTRUCTION.  To  be  tested  by  closing  each 
nostril  in  turn  to  see  if  child  breathes  easily  through  the  open  nostril. 

(34)  TONSILS.^  ''Rem."  means  removed;  ''Enlarged"  indi- 
cates moderate  enlargement;  "Greatly  enlarged"  are  those  nearly 
filling  the  throat;  ''Diseased"  tonsils  are  those  shovv^ing  (1)  cheesy 
plugs,  (2)  localized  injections  of  the  surrounding  vessels.  All  posi- 
tive entries  in  Nos.  30  to  36,  inclusive,  are  to  be  listed  and  referred 
to  specialist  for  absolute  diagnosis. 

(35)  OTHER  ABNORMALITIES.  Here  may  be  noted  any  mal- 
formations such  as  harelip,  cleft  palate,  bifid  uvula,  etc.  All  abnormal 
conditions  of  the  nasopharynx  to  be  listed  and  referred  to  the  spe- 
cialist for  absolute  diagnosis. 

Glands. 

(37)  "ENLARGED"  glands  are  those  over  i  inch  in  diameter; 
"Greatly  enlarged"  glands  are  those  1  inch  in  diameter  or  over.  In 
looking  for  the  infection  associated  with  enlarged  glands,  look 
among  other  causes  for  bites  on  the  body  and  if  present,  examine 
clothing  for  pediculosis  and  the  head  for  nits. 

(37-g)  OTHER— SPECIFY.     Includes  thyroid,  etc. 

Heart. 

(38)  HEART.  Enlargement  to  be  determined  by  axillary  border 
and  apex  beat  if  latter  is  below  the  fourth  or  fifth  interspace  and 
outside  the  mammary  line. 

Lungs. 

Percuss  the  paravertebral  regions  and  listen  with  the  stethoscope 
over  the  bases  and  the  paravertebral  regions. 

(41)  OTHER  DEFECTS.  Asymmetry,  abnormal  shape,  poor 
development,  etc. 

7  For  details  of  hparing  testing,  see  pago  24. 

*  For  details  on  indications  for  recommending  removal  of  tonsils  and  adenoids,  see  page  50, 


20  physical  status  of  preschool  children. 

Skin. 

(51).  OTHER  CONDITIONS.  May  be  included  general  condition 
of  the  skin  such  as  cleanliness,  rough,  dry,  clammy;  also  birthmarks, 
furunculosis,  urticaria,  etc. 

Abdomen. 

(54)  LIVER.  Is  ''enlarged"  if  more  than  1  inch  below  border  of 
ribs.     Specify  in  inches. 

(55)  SPLEEN.  Is  "enlarged"  if  palpable;  ''moderately  en- 
larged" if  1  inch  below  border  of  ribs;  "greatly  enlarged"  if  felt  as 
tumor  mass  in  abdomen. 

(57)  OTHER  DEFECTS.  Note  should  be  made  of  distension 
due  to  tympanites  as  in  rickets,  or  ascites,  etc.,  and  measurements 
taken  at  a  level  of  the  umbilicus,  if  greatly  enlarged  from  any  cause. 

Boxy  ani>  Muscular  System. 

(68)  FLAT-FOOT.  Child  to  be  examined  standing  in  stocking 
feet  or  barefoot,  and  height  of  arch  recorded  in  inches.  This  is  to 
be  measured  with  ruler  held  perpendicularly  from  floor  to  tubercle 
of  scaphoid  bone,  which  is  the  top  of  the  arch.  Observe  child's 
walking  and  record  position  of  feet,  i.  e.,  toes  straight  ahead,  toes  in, 
toes  out. 

(71)  ARTHRITIS.  If  present,  try  to  get  a  history  of  previous 
infections. 

(73)  OTHER  DEFECTS.  Note  flabbiness  of  muscles,  clubbed 
fingers,  tuberculous  bone  affections,  etc.  Record  here  also  in  every 
case  whether  or  not  pronation  of  feet  is  present,  i.  e.,  rotation  of  the 
axis  of  the  foot. 

Nervous  System. 

(77)  OTHER  DEFECTS.     Note  to  be  made  of  extreme  nervous- 

I16SS     ©tc 

MENTAL  CONDITION.  Note  to  be  made  of  sluggish  or  active 
mentality  and  confer  with  teacher  if  questionable. 

Laboratory  Findings. 

In  this  space  may  be  recorded  results  of  urinalysis,  cultures  or 
smears,  from  reports  furnished  by  the  Gary  Board  of  Health  labora- 
tory. 

Previous  Illness. 

This  information  may  be  obtained  only  in  case  the  mother  accom- 
panies the  child  and  can  make  apparently  reliable  statements. 

(83-d)  OTHER.  General  diseases  such  as  rheumatism,  malaria, 
intestinal  parasites,  etc. 

Bad  Habits. 

(84)  Such  as  finger  sucking,  masturbation,  nail  biting,  perverted 
appetites,  enuresis,  etc.  Information  probably  can  be  obtained 
only  from  mother  or  teacher. 


methods  and  standards  used.  21 

Summary  ov  Defects  and  Diseases. 

To  inclii(l(>  all  checked  (lefccts  found  in  general  examination. 

Recommendations. 

These  are  to  be  such  as  will  correct  or  improve  defects  found  by 
referring  to  specialists — correction  of  habits,  dietary  and  general 
hygienic  advice. 

MEASURING   AND   WEIGHING. 

In  an  attempt  to  secure  accurate  figures  on  standing  height  and 
nude  weight,  these  measurements  were  taken  largely  by  one  specially 
instructed  person  in  order  to  eliminate,  so  far  as  possible,  personal 
variations.  Each  measurement  was  made  twice,  once  before  the 
physical  examination  and  once  after,  the  second  figure  serving  as  a 
check  on  the  previous  one. 

Height. 

The  measuring  apparatus  consisted  of  two  pieces  as  follows: 
(1)  A  blue-print  paper  measuring  scale."  The  scale  was  prepared 
from  a  standardized  meter  stick  secured  from  the  United  States 
Bureau  of  Standards,  a  draftsman  making  the  tracing  from  which 
blue  prints  could  be  obtained.  The  strips  of  paper  were  72  inches 
long  and  3  inches  wide,  with  a  scale  divided  into  |-inch  units.  The 
inch  lines  extended  across  the  paper  and  the  half-inch  lines  were 
J  inch  in  length.  The  strips  were  pasted  on  a  smooth  pine  board 
which  could  be  attached  perpendicularly  to  the  floor,  thus  insuring 
a  standard  position  which  is  impossible  in  the  ordinary  room  due 
to  wainscoting  and  sheathing.  For  the  examination  of  infants  too 
young  to  stand,  the  measuring  strip  was  pasted  directly  on  the 
examination  table,  and  a  board  4  by  6  inches  was  fastened  perpen- 
dicularly to  the  end  of  the  table  for  a  headrest.  (2)  Square.  This 
second  essential  part  of  the  measuring  apparatus  was  a  plane  to 
slide  down  over  the  measuring  scale,  when  reading  the  height.  It 
consisted  of  two  pieces  of  wood,  each  6  inches  long,  4  inches  broad, 
and  ^  inch  thick,  fastened  together  at  a  right  angle.  A  crossbar  on 
the  inside  served  as  a  handle  and  further  strengthened  the  apparatus, 
which  simulated  a  book  end  with  a  crossbar. 

The  measurement  of  standing  height  was  made  by  having  the  child 
stand  erect,  arms  hanging  naturally  at  sides,  heels  together,  back 
and  the  back  of  the  head  (the  eyes  in  a  horizontal  plane)  against 
the  board  to  which  the  measuring  scale  was  attached.  The  "book 
end,"  as  the  square  was  sometimes  called,  was  brought  down  firmly 
on  the  top  of  the  head  and  the  reading  taken.     The  4-inch  width  of 

9  This  type  of  scale  was  prepared  after  consultation  with  Dr.  A.  Hrdlicka,  anthropologist  of  the  Smith- 
sonian Institution. 


22  PHYSICAL   STATUS   OF   PRESOHOOL   CHILDREN. 

the  measuring  apparatus  was  a  definite  advantage  in  that  the  inch 
hues  across  tlie  printed  scale  insured  an  accurate  horizontal  position 
of  the  square  because  it  must  not  only  touch  the  top  of  the  head 
firmly  but  also  be  parallel  to  the  longer  lines  across  the  scale. 

The  reclining  length  of  infants  was  taken  by  pushing  the  square 
firmly  against  the  soles  of  the  feet,  which  were  held  at  right  angles 
to  the  table. 

Weight. 

For  weighing  children  who  could  stand,  an  upright  beam  scale 
was  used.  Infants  were  weighed  on  a  grocer's  scoop  scale  with  a 
very  heavy  base,  to  which  the  scoop  was  securely  riveted. 

All  weights  were  taken  without  clothes.  The  flannelette  square 
used  as  a  protection  for  the  child  as  he  came  from  the  dressing  room 
was  removed  and  held  in  front  of  him  by  the  mother  or  nurse  as  a 
screen  while  the  weight  was  taken.  So  far  as  possible,  the  weighing 
was  done  by  one  nurse  who  had  been^specially  instructed  in  the 
importance  of  accuracy  in  adjusting  the  balance  of  the  scale  several 
times  daily  and  reading  the  record  of  weight  with  the  beam  hori- 
zontal or  at  mid-balance.  After  the  physical  examination  the  child 
was  reweighed,  and  the  second  reading  was  checked  up  with  the 
original  figures  before  entry  was  made  on  the  record  form. 

The  height  and  weight  table  used  as  a  standard  was  that  prepared 
by  the  Children's  Bureau  for  the  weighing  and  measuring  test  during 
the  Children's  Year  campaign,  the  averages  for  children  at  birth  and 
for  boys  at  3  months  having  been  taken  from  Dr.  L.  Emmett  Holt's 
figures  from  original  observation;  those  for  children  aged  6  to  48 
months,  from  the  antlii'opometric  table  compiled  by  F.  S.  Crum;  and 
those  for  children  aged  5  to  7  years,  inclusive,  from  Bowditch.  Since 
all  the  children  included  in  this  study  were  weighed  without  clothing 
and  the  Bowditch  figures  included  weight  of  clothing,  it  was  necessary 
to  deduct  from  the  latter  the  average  weight  of  clothes  (Bowditch's 
averages.)^** 

In  order  to  economize  time  as  well  as  to  eliminate  possible  errors 
through  hasty  computation,  this  table  was  adapted  for  the  use  of  the 
examining  physicians,  weights  being  shown  in  haK-year  periods, 
decimal  or  fractional  pounds  being  changed  to  ounces  and  decimal 
inches  to  fractional  inches.  Weights  10  per  cent  below  the  accepted 
averages  were  also  computed  and  arranged  in  a  column  parallel  to 
the  corresponding  averages.  The  saving  of  time,  the  elimination  of 
the  possible  chances  of  mathematical  error,  and  the  uniformity  of 
method  made  possible  are  obvious.  The  adapted  table  is  here  given, 
since  it  offers  some  practical  suggestions,  although  its  form  could  be 
more  conveniently  arranged. 

»o  See  The  Diseases  of  Infancy  and  Childhood,  by  L.  Emmett  Holt,  M.  D.,  p.  19.    New  York,  1916. 


= IZ- 


MEASURING 


^ — 5 


^—4- 


== — 3 


m^' 


—  I 


0 


MEASURING  SQUARE. 


22— i 


MEASURING    STRIP. 
Scale   I   inch    equals    1    inch. 


jXTJCaUM-' 

s  3i€»  csxc:  axe  arr?  ~  :n 


WEIGHING     IN    SCOOP    SCALE. 


22—3 


WEIGHING    ON    BEAM    SCALE. 


VISION    TESTING. 


HEARING    TESTING. 


METHODS   AND   STANDARDS   USED.  23 

Heights  and  weights  of  hoys.  Heights  and  weights  of  girls. 


Height. 


"Weight. 


10  per 

cent 

below 

average. 


Average. 


Inches. 
20i 
23J 
26i 
2"i 
271 
2Si 
28i 
29 
291 

291 
30J 
30J 
31i 

aif 

SIJ 
32i 
321 
32i 
33i 
33f 
33| 

34 

34J 

34J 

35i 

35* 

35| 

35J 

36 

36i 

36J 

36i 

37J 

371 

37i 

37i 

38i 

381 

381 

38i 

381 

39 

39 

39J 

39§ 


41f 
42f 
43| 
44| 
45f 
461 
47| 
48| 
49f 
SOJ 
51J 


Lbs.  Oz. 

6  13 

11  11 

16  3 

17  3 

17  12 

18  5 

18  13 

19  4 

19  11 

20  9 

20  11 

21  4 

21  11 

22  1 
22  3 
22  15 


26 

26  9 

27  7 
27  9 

27  9 
28 

28  11 
29 

29 

29  2 

29  13 

30  2 
30  4 
30  6 
30  6 

30  13 

31  1 

31  4 

32  3 

32  5 

33  6 

34  7 
36  5 

38  2 

39  10 
41 

43  3 

45  5 

47  12 

50  2 

51  15 
53  10 


Lbs.  Oz. 

7  9 
13 
18 

19  2 

19  12 

20  6 

20  14 

21  6 

21  14 

22  14 
23 

23  10 

24  2 
24  8 

24  10 

25  8 
25  12 

25  12 

26  14 
27 

27  2 


27  14 

28  4 
29 

29  2 
29  4 

29  8 

30  8 
30  10 

30  10 

31  2 

31  14 

32  4 

32  4 

32  6 

33  2 
33  8 
33  10 
33  12 

33  12 

34  4 
34  8 

34  12 

35  12 
35  14 


Age. 


Birth 

3  months. . 

6  months. . 

7  months.. 

8  months  . 

9  months. . 

10  months. 

11  months. 

12  months. 


13  months- 

14  months. 

15  months. 

16  months. 

17  months. 

18  months 

19  months. 

20  months. 

21  months. 

22  months. 

23  months. 

24  mouths. 

25  months. 

26  months. 

27  months. 

28  months. 

29  months. 

30  months. 

31  mouths. 

32  months. 

33  months. 

34  months. 

35  months., 

36  months. 


37  months. 

38  months. 

39  months. 

40  months. 

41  months. 

42  months. 

43  months. 

44  months. 

45  months. 

46  months. 

47  months. 

48  months. 


55  11 
57  11 
59      9 


4i  years . 

5  years . . 
5 J  years . 

6  years . . 
6 J  years . 

7  years . . 
7J  years . 

8  years. . 
8§ years. 

9  years . . 
9i  years. 

10  years . 


Height. 


Inches. 
20i 


25i 

26* 

27 

271 

27J 

28J 

281 

291 
29i 

m 

30J 

30| 

31J 

31i 

32 

32} 

321 

321 

33f 

334 
331 
331 
341 
34J 
341 
35J 
351 
35| 
36i 
36i 
36J 

36| 

37 

37i 

37i 

37J 

38 

38i 

38i 

38i 

3St 

m 

39 

40J 
41i 
42| 
431 
«i 
45i 
46| 
471 
48J 
49f 
50| 
51i 


Weight. 


10  per 

cent 

below 

average. 


Lbs.  Oz. 

6  8 

i5  'i 

15  10 

16  7 

17  3 

17  9 

18  2 
18  11 

18  14 

19  7 

19  11 

20  6 

20  9 

21  1 
21  6 

21  11 

22  .4 

22  12 

23  1 

23  12 

24  3 
24  8 

24  8 
25 

25 

25  7 
25  14 


Average. 


27  11 

27  14 

28  7 

28  13 
29 

29  4 
29  8 
29  11 
29  15 


31  13 

33  3 

34  13 
36  7 
38 

39  8 

41  10 

43  8 

45  15 

48  3 

50  3 

52  1 


Lbs.    Oz. 

7   3 


16  12 

17  6 


20  12 

21 

21  10 

21  14 

22  10 

22  14 

23  6 

23  12 

24  2 

24  12 

25  4 

25  10 

26  6 

26  14 

27  4 
27  4 
27  12 

27  12 

28  4 
28  12 
29 


30  12 
31 

31  10 
32 

32  4 
32  8 

32  12 
33 

33  4 
33  8 
33  8 
33  12 

35  6 

36  14 
38  11 
40  8 
42  4 
44 

46  4 


55  12 
57  14 


VISION   TESTING. 


The  "illiterate"  chart  was  the  one  used  for  testing  the  vision  of 
these  children,  most  of  whom  were  too  young  to  know  the  alphabet. 
This  chart  consists  of  eight  rows  of  letter  E's,  gradually  diminishing  in 
size  and  turned  in  four  different  positions.     The  child  was  given  a 


24  PHYSICAL   STATUS    OF   PRESCHOOL    CHILDREX. 

pasteboard  letter  E  and  instructed  how  to  turn  it  to  correspond  to 
the  position  of  the  particuhir  letter  in  the  cliart  at  which  the  nurse 
pointed.  The  child's  own  fingers  could  also  be  used  to  indicate  the 
position  of  the  fingers  of  the  E.  At  the  side  of  each  row  of  letters 
there  was  a  number  which  indicated  the  distance  in  feet  at  which  the 
letter  should  be  read  by  a  normal  eye.  The  large  letter  at  the  top 
should  be  read  at  a  distance  of  200  feet:  the  other  rows  at  100,  65,  50, 
39,  25,  20,  and  15  feet. 

The  cMld  was  placed  at  a  distance  of  20  feet  from  the  chart.  If  he 
could  then  turn  his  letter  correctly  to  correspond  to  the  letters  on  the 
20-foot  line,  he  was  given  a  grade  of  %%.  If  he  could  not  see  that  line 
but  could  see  the  large  line  above,  he  was  given  a  grade  of  f 5 ,  the 
numerator  of  the  fraction  being  always  the  distance  between  the 
chart  and  the  child,  and  the  denominator  indicating  the  line  which  the 
child  could  see.  A  child  who  received  a  grade  of  |^  saw  only  two- 
thii'ds  of  what  he  should  see;  one  who  received  |^  saw  only  two-fifths 
of  what,  he  should  see.  Every  child  whose  vision  grade  was  ?r%  or 
less  was  referred  to  an  eye  specialist.  If  a  child's  vision  was  so  poor 
that  at  a  distance  of  20  feet  from  the  chart  he  could  not  see  the  top 
letter,  which  should  have  been  visible  at  200  feet,  he  was  moved 
toward  the  chart  until  he  could  see  it,  and  the  distance  between  him 
and  the  chart  was  then  measured.  For  instance,  a  child  might 
receive  a  grade  of  -^.  Vision  graded  ^  was  considered  ''slightly 
defective"  and  not  necessarily  requiring  glasses,  but  when  a  child 
received  such  a  grade  the  mother  was  advised  to  keep  his  vision 
under  observation;  vision  graded  ^%  or  worse  was  tabulated  as 
"seriously  defective"  and  requiring  glasses. 

Important  details  to  be  observed  in  testing  vision  by  this  method 
are: 

1.  Have  the  child  stand  20  feet  away  from  the  chart. 

2.  Always  test  the  right  eye  first. 

3.  Use  a  card  to  cover  one  eye  while  testing  the  other,  being  careful  not  to  press  on 

the  covered  eye. 

4.  Use  a  bright-colored  pointer,  such  as  a  red  penholder. 

5.  Do  not  point  to  the  same  letter  consecutively,  since  that  tends  to  puzzle  the  child. 

6.  Place  the  pointer  directly  under  the  letter,  being  careful  not  to  touch  the  letter 

at  any  point. 

7.  Do  not  spend  a  great  length  of  time  on  the  larger  letters.     If  you  are  couA-inced 

that  the  child  sees  them  readily,  pass  on  to  the  lower  lines  before  the  child  grows 
tired  or  loses  interest. 

8.  Always  try  the  letters  which  are  easiest  for  the  child  to  see,  and  if  the  light  is 

better  on  one  side  of  the  chart,  as  for  instance  when  a  lamp  is  used,  point  to  the 
brightest  letters. 

HEARING   TESTING. 

In  the  hearing  test  the  child  stood  20  feet  away  from  the  nurse 
who  made  the  examinations,  \\dth  his  head  turned  so  that  his  right 
ear  was  toward  her  and  with  his  finger  in  his  left  ear.     The  "  whispered 


METHODS   AND   STANDARDS   USED.  25 

voice"  was  used — simple  numbers  and  phrases  whispered  on  tlie 
exhalation  of  a  breath,  66  or  any  other  number  ending  in  6  being 
avoided.  After  the  right  ear  was  tested  the  child  was  faced  about 
and  the  left  ear  was  tested  in  the  same  manner.  The  repetition  of 
the  number  or  phrase  heard  indicated  the  child's  ability  to  hear. 
The  advantage  of  having  the  same  person' conduct  all  the  hearing 
tests  is  self-evident,  since  individual  variations  in  pitch  of  voice, 
enunciation,  etc.,  in  a  number  of  examiners  might  result  in  imeven 
grading. 

A  cliild  standing  20  feet  away  from  the  nurse  and  repeating  cor- 
rectly the  whispered  words,  received  a  grade  of  |^.  If  the  child  had 
defective  hearing,  the  nurse  advanced  slowly  toward  him  until  he 
could  hear  what  she  was  saying.  The  gi'ade  was  then  determined  by 
measuring  the  distance  between  the  child  and  the  nurse.  For 
instance,  a  child  might  receive  a  grade  of  ^.  All  cases  of  defective 
hearing  were  referred  to  a  specialist.  In  the  tabulations,  hearing 
was  entered  as  "slightly  defective"  if  the  grade  was  between  ^  and 
^,  and  "seriously  defective"  if  it  was  less  than  ^, 

INDICATIONS  FOR  RECOMMENDLXG  REMOVAL   OF  TONSILS 
AND  ADENOIDS. 

A  difficult  point  in  the  consideration  of  naso-pharyngeal  defects  in 
children  is  the  decision  as  to  what  cases  shall  be  listed  as  having 
enlarged  tonsils  and  adenoids.  The  fact  that  standards  for  deter- 
mining this  have  varied  greatly  among  different  examiners  is  proved 
by  the  greatly  varying  percentages  of  this  defect  recorded  by  differ- 
ent medical  school  inspectors.  Specialists  differ  greatly  in  their 
estimate  of  what  are  enlarged  tonsils  and  what  forms  an  indication 
for  their  removal.  Tliis  obvious  difference  in  standards  is  largely 
due  to  the  fact  that  hyperplasia  of  lymphoid  tissue  is  physiological 
in  young  children,  and  that  normal  tonsils  are  proportionately  larger 
in  children  than  in  adults. 

In  this  study  it  was,  in  the  first  place,  found  necessary  for  statistical 
purposes  to  determine  definite  standards  for  making  the  entries  on 
the  record  form;  it  was  also  necessary  that  each  of  the  symptoms 
present  be  definitely  outlined  before  removal  of  tonsils  was  recom- 
mended. From  the  standards  which  follow  it  is  evident  that  a  very 
conservative  point  of  view  was  taken  in  making  recommendations 
for  removal  of  tonsils  or  adenoids. 

Difficulties,  of  course,  arise  in  deciding  whether  removal  of  tonsils 
and  adenoids  is  indicated,  when  examining  a  group  of  children  from 
many  of  whom  no  history  can  be  obtained.  The  history  of  previous 
attacks  of  tonsilhtis,  and  of  habitual  mouth  breathing  and  snoring  at 
night,  are  important  factors  in  making  the  decision.  In  doubtful 
cases  where  no  history  could  be  obtained,  no  recommendation  for 


26  PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN. 

removal  of  tonsils  and  adenoids  was  made;  but  it  was  recommended 
that  the  child  be  examined  again  by  a  tln-oat  speciahst,  and  the 
throat  conditions  watched. 

The  following  was  the  basis  on  which  recommendations  were  made 
for  the  removal  of  (1)  tonsils,  (2)  adenoids,  or  (3)  tonsils  and  adenoids. 

1.  Indications  for  removal  of  tonsils: 

( «)  Greatly  enlarged  tonsils,  practically  filling  the  throat  and  making  breathing 

difficult;  or 
(6)  Moderately  enlarged  tonsils  with  repeated  attacks  of  tonsillitis,  ioui'  or 

five  a  year;  or 

(c)  Moderately  enlarged  tonsils  with  a  severe  systemic  infection,   siich  as 

heart,  joints,  etc. ;  or 

(d)  Greatly  enlarged  submaxillar%'  glands,  together  with  moderately  enlarged 

tonsils. 

(e)  Diseased  tonsils;  i.  e.,  showing  cheesy  plugs. 

Where  moderately  enlarged  tonsils  were  found  but  the  above 
positive  indications  were  not  present,  no  recommendations  ior 
removal  were  made. 

2.  Indications  for  removal  of  adenoids: 

(a)  IMarked  mouth  breathing  with  adenoid  facies,  in  a])sence  of  other  causes 

of  nasal  obstiiiction. 
(&)  History  of  habitual  snoring  and  mouth  breathing  at  night  (only  to  be 

obtained  where  the  mother  was  present  at  the  examination  i. 

(c)  Chronic  nasal  discharge  \vith  marked  excoriation  of  the  lip  (simple  colds 

excluded  1. 

(d)  Marked  retraction  of  the  ear  drums. 

(e)  Soft  palate  standing  off  from  the  posterior  wall  of  the  phar^iix. 

3.  Indications  for  removal  of  tonsils  and  adenoids: 

The  indications  here  would  be  a  combination  of  those  of  (1)  and  (2). 

A  digital  examination  for  adenoids  was  not  undertaken  in  making 
these  examinations,  as  it  was  not  considered  feasible.  In  all  cases 
where  a  child  was  examined  to  see  whether  an  operation  for  the 
removal  of  tonsils  and  adenoids  was  indicated,  or  whether  the  case 
should  merely  be  watched,  an  examination  of  the  drum  membrane 
was  made. 

Mouth  breathing  not  of  marked  degree  (i.  e.,  that  which  has  not 
caused  any  facial  deformity  and  that  of  a  child  who  breathes  through 
his  nose  during  the  examination,  even  though  he  has  been  observed 
to  breathe  through  his  mouth  when  not  self-conscious)  w^as  not  con- 
sidered an  indication  for  removal  of.  adenoids.  The  recommenda- 
tion in  these  cases  was  that  the  child  be  watched  and  that  a  speciahst 
be  consulted  again  if  the  mouth  breathing  continued. 


PHYSICAL  FINDINGS. 


INTRODUCTION. 


The  term  ''preschool,"  while  literally  referring  to  the  years  of  life 
prior  to  school  attendance,  necessarily  applies  to  a  period  of  variable 
length,  inasmuch  as  school  entrance  ages  in  different  sections  of  the 
country  range  from  5  to  8  years.  Clinically,  early  childhood  has 
long  been  divided  into  two  periods,  viz.,  infancy,  the  first  two  years 
of  life,  and  the  preschool  age,  from  2  to  6  or  7  years.  In  this  study 
the  term  ''preschool"  covered  the  period  2  to  6  years  inclusive." 

A  very  considerable  proportion,  about  50  per  cent,  of  all  the  chil- 
dren of  preschool  age  in  Gary  were  given  physical  examinations. 
The  proportions  of  different  ages  who  had  physical  examinations 
varied  from  approximately  one-third  of  the  children  3  years  of  age 
to  about  two-thirds  of  the  6-year-old  children. 

Nearly  one-half  (1,544)  of  the  3,125  children  of  this  group  given 
physical  examinations  were  attending  kindergarten  or  primary 
grades,  and  the  examinations  were  made  in  their  respective  schools. 
The  remaining  1,581  children  were  attendants  at  the  health  confer- 
ences.^^ 

A  singularly  even  distribution  by  sex  is  noticed  in  the  entire  group 
as  well  as  at  each  age. 

Table  I. — Age  and  sex;  children  from  2  to  7  years  of  age  given  physical  examination. 


Age. 


All  ages... 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6. 
C  years,  mider  7 
7  years,  under  8. 


Both 

sexes. 


549 
667 
6S2 
220 


Bovs. 


261 
251 
274 
337 
334 


Girls. 


1,570 


250 
245 
275 
330 
348 
122 


To  what  extent  the  social  and  economic  environment  of  these 
children  affected  their  physical  condition  would  be  difficult  to  deter- 
mine; but  a  consideration  of  the  nationality  and  income  of  parents 
in  relation  to  physical  conditions  offers  interesting  data. 


11  For  explanation  of  inclusion  see  Note  1,  page  12. 
"Seepage  11. 


27 


28 


PHYSICAL   STATICS   OF   PRESCHOOL   CHILDREN. 


Children  of  foreign-born  white  mothers  constituted  60.7  per  cent 
of  the  cliihh'en  in  this  study.  The  principal  nationalities  represented 
were  Serbo-Croatian,  Slovjik,  Polish,  Magyar,  Italian,  Gerniaii,  and 
Lithuanian.     (See  General  Table  10,  p.  72.) 

Family  incomes  were  tabulated  in  groups  ranging  from  those  below 
$650  to  those  of  $2,2.50  and  over.  Practically  two-thirds  of  all  the 
children  of  foreign-born  white  parentage  belonged  to  the  lower  in- 
come groups,  i.  e.,  those  under  $1,450.     (See  General  Table  12,  p. 

73.) 

FINDINGS   IN    GENERAL. 

Table  II  gives  an  enumeration  of  the  kinds  of  defects  found  and 
their  distribution  according  to  sex.  The  boys  on  the  whole  showed 
a  slightly  higher  percentage  having  defects  than  the  girls,  96.9  com- 
pared with  93.6.  The  large  proportion  of  boys  with  genital  defects 
(47.1  per  cent)  unquestionably  accounts  largely  for  this  variation  be- 
tween the  sexes,  although  dominance  in  defects  of  the  nasopharynx, 
bony  and  muscular  systems,  and  glands  also  helped  to  swell  the  higher 
percentage  for  boys. 


Table  II. — Prevalence  of  defects,  by  sex;  children 

examination. 


to  7  years  of  age  given  physical 


Disease  or  defeft. 


Num- 
ber. 


Total. 


Without  defects 

Witti  disease  or  defect. 


Oeneral: 

Underweight  (10  per  cent  and  over) . 

Anemia 

Head 

Abnormal  shape 

Open  f ontaneUe 

Craniotabes 


149 
2,976 


Eyes. 


Vision  defective 

Diseases  and  defects  other  than  of  vision 

Conjunctivitis 

Blepharitis 

Stye 

Corneal  ulcer 

Ptosis 

Corneal  opacities 

Strabismus 

Ears. 


Hearing  defective. . . . 

Acute  otorrhea 

Chronic  otorrhea 

Retracted  ear  drums . 

Mouth 

Decayed  teeth 

Malocclusion 

Gum  abscess 


303 

2^3 

163 

151 

13 

2 

1  890 

738 

245 

78 

70 

28 

1 

13 
11 
76 
<295 
25 
3 

22 

258 

2,091 

2,021 

343 

101 


Per 

cent. 


4.8 
95.2 


9.7 

7.8 

5.2 

4.8 

.4 

.1 

28.5 

2  36.1 

7.8 

2.5 

2.2 

.9 

(') 

.4 

.4 

2.4 

9.4 

5  1.4 

.1 
.7 

6  8.3 
66.9 
64.7 
11.0 

3.2 


Boys. 


Num- 
ber. 


1,507 


140 

113 

105 

102 

5 

1 

437 

355 

127 

42 

38 

16 

1 

7 

7 

33 

171 

14 

2 

15 

148 

1,043 

1,007 

163 

53 


Per 
cent. 


3.1 

96.9 


9.0 

7.3 

6.8 

6.6 

.3 

.1 

28.1 

235.6 

8.2 

2.7 

2.4 

1.0 

.1 

.5 

.5 

.21 

11.0 

f'  1.6 

.1 

1.0 

6  9.5 

67.1 

64.8 

10.5 

3.4 


Girls. 


Num- 
ber. 


1,570 


101 
1,469 


163 
130 

58 

49 

8 

1 

453 

383 

118 

36 

32 

12 


6 

4 

43 

124 

11 

1 

7 

110 

1,048 

1,014 

180 

48 


Per 

cent. 


100.0 


6.4 
93.6 


10.4 

8.3 

3.7 

3.1 

.5 

.1 

28.9 

2  36.6 

7.5 

2.3 

2.0 

.8 


.4 

.3 

2.7 

7.9 

6  1.2 

.1 
.4 
6  7.0 
66.8 
64.6 
11.5 
3.1 


1  In  1,081  cases,  vision  was  not  tested;  hence  this  number  does  not  include  all  possible  cases  of  defective 
vision. 

2  Per  cent  based  on  2,044  cases  tested,  998  boys  and  1,046  girls, 
s  Less  than  one-tenth  of  1  per  cent. 

<  In  1,279  cases,  hearing  was  not  tested;  hence  this  number  does  not  include  all  possible  cases  of  defective 
hearing. 
6  Per  cent  based  on  1,846  cases  tested,  901  boys  and  945  girls. 
6  A  minimum  statement — not  all  children  were  examined  for  this  defect. 


PHYSICAL  FINDINGS. 


29 


Table  II. — Prevalence  of  defects,  by  sex;  children  2  to  7  years  oj  age  given  physical 

examination — Concluded . 


Disease  or  defects. 


With  disease  or  defect — Continued. 
Naso-pharynx 

Defective  tonsils 

Adenoids  (definite) 

Adenoids  suspected 

Mouth  lireathing 

Nasal  discharge 

High-arch  jialate 

Nasal  obstruction 

Glands:  . 

Enlarged  or  greatlj'  enlarged. 

Occipital  glands 

Sulnnaxillary  glands 

Cervical  glands 

Axillary  glands 

Inguinal  glands 

Thyroid  glands 

Heart 

Heart  disease 

Questionable  heart  disease. . . 
Lungs 

Lung  disease 

Questionable  lung  disease 

Skin 

Eczema 

Acne 

Pediculosis 

Impetigo 

Infected  sores 

Ringworm 

Scabies 

Scars 

Abdomen 

Distended  abdomen 

Enlarged  liver 

Hernia 

Bony  and  muscular  system 

Beaded  ribs 

Pigeon  breast 

Harrison's  groove 

Enlarged  epiphyses 

Round  shoulders 

Winged  scapulse 

ScoUosis 

Lordosis 

Kyphosis 

Knock-knee 

Bowlegs 

Clubfeet 

Arthritis 

-     Paralysis 

Nervous  system 

Speech  defect 

Tic 

Chorea 

Other  nervous  disease 

Very  nervous  or  restless 

MentaUty 

Defect  apparent 

Defect  suspected 

GenitaUa,  male 

Prepucial  defects 

Other  defects 

Genitalia,  female: 

Vaginal  discharge 


Both  sexes. 


Num- 
ber. 


2,157 
1,620 
1,050 

207 
1,232 

299 
1,027 
1,194 


2 

704 

241 

15 

51 

60 

99 

14 

85 

32 

11 

21 

318 

80 

1 

145 

8 

67 

29 

9 

165 

464 

423 

11 

47 

1,308 

31 

53 

175 

209 

ia3 

452 

57 

16 

1 

194 

300 

4 

3 

5 

75 

54 

8 

1 

4 

12 

37 

19 

18 


Per 
cent. 


69.0 
52.0 
33.6 

6.6 
39.4 

9.6 
32.9 
38.2 

29.1 

.1 

22.5 

7.7 

.5 

1.6 

1.9 

3.2 

.4 

2.7 

1.0 

.4 

.7 

10.2 

2.6 

(') 

4.6 

.3 

2.1 

.9 

.3 

5.3 

14.8 

13.5 

.4 

1.5 

41.9 

1.0 

1.7 

5.6 

6.7 

3.3 

14.5 

1.8 

.  5 

(') 

6.2 

9.6 

.1 

.1 

.2 

2.4 

1.7 


Boys. 


(1) 


.1 
.4 
1.2 
.6 
.6 


Num- 
ber. 


1,118 
836 
570 
106 
670 
157 
535 
651 

489 
1 
3.83 
143 
12 
38 
21 


39 

21 

6 

15 

137 

49 

1 

35 

3 

35 

18 

5 

97 

234 

214 

5 

24 

709 

15 

38 

112 

146 

62 

238 

27 

10 

1 

92 

193 

3 

2 

4 

42 

28 

5 

1 

3 

7 

26 

12 

14 

732 

719 

22 


Per 

cent. 


71.9 
53.8 
36.7 
6.8 
43.1 
10.1 
34.4 
4L9 

31.4 

.1 

24.6 

9.2 

.8 

2.4 

1.4 

3.1 

.6 

2.5 

1.4 

.4 

1.0 

8.8 

3.2 

.1 

2.3 

.2 

2.3 

1.2 

.3 

6.2 

15.0 

13.8 

.3 

1.5 

45.6 

1.0 

2.4 

7.2 

9.4 

4.0 

15.3 

1.7 

.6 

.1 

.5.9 

12.4 

.2 

.1 

.3 

2.7 

1.8 

.3 

.1 

.2 

.5 

.7 

.8 

.9 

47.1 

46.2 

1.4 


Girls. 


1. 


Num- 
ber. 


1,039 
790 
480 
101 
562 
142 
492 
543 

419 

1 

321 

98 

3 

13 

39 

51 

5 

46 

11 

5 

6 

181 

31 


110 

5 

32 

11 

4 

68 

230 

209 
6 
23 

599 
16 
15 
63 
63 
41 

214 
30 


102 

107 

1 

1 

1 

33 

26 

3 


Per 

cent. 


66.2 
50.3 
30.6 

6.4 
35.8 

9.0 
31.3 
34.6 

26.7 

.1 

20.4 

6.2 
.2 
.8 

2.5 

3.2 
.3 

2.9 

.7 

.3 

.4 

11.5 

2.0 


7.0 

.3 

2.0 

.7 

.3 

4.3 

14.6 

13.3 

.4 

1.5 

38.2 

1.0 

1.0 

4.0 

4.0 

2.6 

13.6 

1.9 

.4 


6.5 
6.8 
.1 
.1 
.1 
2.1 
1.7 
.2 


1  Less  than  one- tenth  of  1  per  cent. 


The  actual  number  of  children  without  physical  defects  was  found 
to  be  only  4.8  p)er  cent  of  those  examined — 149  out  of  3,125.  The 
girls,  of  whom  6.4  per  cent  were  without  defect,  made  a  more  fa- 


30 


PHYSICAL  STATUS  OF   PRESCHOOL   CHILDREl^J". 


vorable  showing  than  the  boys,  with  only  3.1  per  cent  free  from 
defect. 

Boys  also  had  the  larger  number  of  defects  per  individual,  44.8 
per  cent  having  5  or  more,  as  compared  with  31.2  per  cent  of .  the 
girls.  The  average  number  of  defects  per  child,  based  on  all  those 
who  had  defects,  was  4.2  for  both  sexes,  4.5  for  boys,  and  3.8  for 
girls.  This  average  for  the  different  age  groups  was  as  follows :  For 
the  2-year-olds,  2.7;  for  the  3-year-olds,  3.1;  and  for  the  4-,  5-, 
and  6-year-olds,  3.5,  4.8,  and  5,  respectively.  The  proportion  with 
no  defects  decreased  from  15.1  per  cent  at  2  years  to  0.3  per  cent  at 
6  years. 

Table  III. — Number  of  defects,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination. 


Total 

2  years, 

3  years, 

4  years, 

5  years, 

6  vears, 

7  vears, 

children. 

under  3. 

under  4. 

under  5. 

uiider  6. 

under  7. 

under  8. 

Number  of  de- 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

fects,  and  sex. 

cent 

cent 

cent 

cent 

cent 

cent 

cent 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

Iri- 
bu- 

ber. 

tri- 
bu 

tion. 

tion. 

tion. 

tion. 

tion. 

tion. 

tion. 

Both  sexes . 

3,125 

100.0 

511 

100.0 

496 

100.0 

549 

100.0 

6r,7 

100.0 

682 

100.0 

220 

100.0 

With  defects . . . 

2,976 

9.5.2 

4.-!4 

84.9 

455 

91.3 

531 

96.  7 

660 

99.0 

680 

99.7 

218 

99.1 

Less  than  5. 

1, 789 

.57.2 

37  ^ 

73. 0 

361 

72.8 

352  1  64. 1 

324 

48.6 

286 

41.9 

93 

42.3 

1 

332 

10.  6 

125 

24.  5 

84 

16.9 

48 

8.7 

38 

5.7 

27 

4.0 

10 

4.5 

2 

440 

14.1 

116 

22.7 

111 

22.4 

70 

12.8 

66 

9.9 

60 

8.8 

17 

7.7 

3 

537 

17.2 

85 

16.6 

96 

19.4 

131 

2.3.9 

95 

14.2 

98 

14.4 

32 

14.5 

4 

480 

1.5. 4 

47 

9.2 

70 

14.1 

103 

18.8 

125 

18.7 

101 

14.8 

34 

15. 5 

5to0 

1,123 

35.9 

60 

11.7 

90 

18.1 

172 

31.3 

311 

46.6 

372 

54.  5 

lis 

fili.a 

5 

426 

1.3.6 

31 

6.1 

56 

11.3 

59 

10.7 

124 

18.6 

122 

17.9 

34 

1.5.5 

6 

316 

10.1 

16 

.3.1 

18 

,3.6 

63 

11.5 

79 

11.8 

96 

14.1 

44 

20.0 

7 

196 

6.3 

6 

1.2 

9 

1.8 

32 

5.8 

47 

7.0 

84 

12.3 

IS 

8.2 

8 

123 

3.9 

3 

.6 

4 

.8 

10 

1.8 

43 

6.4 

48 

7.0 

15 

6.8 

9 

62 

2.0 

4 

.8 

3 

.6 

8 

1.5 

18 

2.7 

22 

.3.2 

7 

3.2 

10  to  15 

64 

2.0 

1 

2 

2 

.4 

7 

1.3 

25 

3.7 

22 

3.2 

7 

3.2 

10 

30 
21 

8 
3 
1 

1 

1.0 
.7 
.3 

1 

.2 

1 
3 
2 

.2 
.5 
.4 

8 
13 
3 

1 

L2 
1.9 
.4 
.1 

16 
1 
3 
2 

2.3 
.1 
.4 

.3 

4 
2 

1.8 

11. 

2 

.4 

.9 

12 

13. 

.1 

(') 
0) 

14 



1 

.2 

15 



1 

5 

Without  defects 

149 

4.8 

77 

15.1 

43 

8.7 

18 

.3.3 

7 

1.0 

2 

.3 

2 

.9 

Boys 

1,555 

100.0 

261 

100.0 

251 

100.0 

274 

100.0 

337 

100.0 

334 

100.0 

98 

100.0 

With  defects . . . 

1,507 

96.9 

235 

90.0 

237 

94.4 

269 

98.2 

335 

99.4 

333 

99.7 

98 

100.0 

Less  than  5. 

810 

52.1 

194 

74.3 

174 

69. 3 

156 

56.9 

133 

39.5 

117 

35.0 

36 

36.7 

1 

136 

8.7 

57 

21.8 

32 

12.7 

17 

6.2 

15 

4.5 

9 

2.7 

6 

6.1 

2 

181 

11.6 

57 

21.8 

59 

23.5 

26 

9.5 

18 

5.3 

18 

.5.4 

3 

.3.1 

3 

242 

1.5.6 

45 

17.2 

44 

17.5 

61 

22.3 

39 

11.6 

40 

12.0 

13 

13.3 

4 

251 

16.1 

35 

13.4 

.39 

15.5 

52 

19.0 

61 

18.1 

.50 

15.0 

14 

14.3 

5to9 

652 

41.9 

41 

15.7 

61 

24.3 

108 

39.4 

184 

64.6 

202 

60.5 

.56 

,57.1 

5 

Zii 

15.0 

19 

7.3 

34 

13.5 

36 

13. 1 

65 

19.3 

63 

18.9 

16 

16.3 

6 

184 

11.8 

12 

4.6 

16 

6.4 

.36 

13. 1 

49 

14.5 

47 

14.1 

24 

24.5 

7 

121 

7.8 

4 

1.5 

4 

1.6 

24 

8.8 

31 

9.2 

50 

15.0 

8 

8.2 

8 

74 

4.8 

2 

.8 

4 

1.0 

8 

2.9 

26 

7.7 

28 

8.4 

6 

6.1 

9 

40 

2.6 

4 

1.5 

3 

1.2 

4 

1.5 

13 

3.9 

14 

4.2 

9 

2.0 

10  to  15 

45 
21 
15 
5 
2 
1 
1 
48 

2.9 
1.4 
1.0 
.3 
.1 
.1 
.1 
3.1 

2 

.8 

5 

1 
2 
1 

1.8 
.4 
.7 
.4 

18 
5 

10 
2 
1 

5.3 
1.5 
3.0 
.6 
.3 

14 
11 

4.2 
3.  3 

0 
4 
1 

6.1 

10 

4  1 

11 

^ 

.8 

1.0 

12 

i 

.6 
.3 

13 

14 

1 

.4 

15 

1 


1.0 

Without  defects 

26 

10.0 

14 

5.6 

5 

1.8 

2 

.6 

1 

.3 

Girls 

1.570 

100.0 

250 

100.0 

245 

100.0 

275 

100.0 

.330 

100.0 

348 

100.0 

122 

100.0 

1  Less  than  one-tenth  of  1  per  cent. 


PHYSICAL,  FINDINGS. 


31 


Table  III. — Number  of  defects,  by  age  and  sex;  children  2  to  7  years  of  age  given  physi- 
cal examination — Concluded. 


Total 

2  years, 

3  years, 

4  years, 

5  years. 

6  years. 

7  years. 

. 

children. 

under  3. 

imder  4. 

under  5. 

under  6. 

under  7. 

under  8. 

Number  of  de- 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

fects,  and  sex. 

cent 

cent 

cent 

cent 

cent 

cent 

cent 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Num- 

dis- 

Nimi- 

dis- 

Num- 

dis- 

ber. 

tri- 
hu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

ber. 

tri- 
bu- 

tion. 

tion. 

tion. 

tion. 

tion. 

tion. 

tion. 

With  defects . . . 

1,469 

93.6 

199 

79.6 

216 

88.2 

262 

95.3 

325 

98.5 

347 

99.7 

120 

98.4 

Less  than  5. 

979 

62.4 

179 

71.6 

187 

76.3 

196 

71.3 

191 

57.9 

169 

48.6 

57 

46.7 

1 

196 

12.5 

68 

27.2 

52 

21.2 

31 

11.3 

23 

7.0 

18 

5.2 

4 

3.3 

2 

259 

16.5 

59 

23.  6 

52 

21.2 

44 

16.(1 

48 

14.5 

42 

12.1 

14 

11.5 

3 

295 

18.8 

40 

16.0 

52 

21.2 

70 

25.5 

56 

17.0 

58 

16.7 

19 

15.6 

i 

229 

14.6 

12 

4.8 

31 

12.7 

51 

18.5 

64 

19.4 

51 

14.7 

20 

16.4 

5to9 

471 

30.0 

19 

7.6 

29 

11.8 

64 

23.3 

127 

38.5 

170 

48.8 

62 

50.8 

5 

193 

12.3 

12 

4.8 

22 

9.0 

23 

8.4 

59 

17.9 

59 

17.0 

18 

14.8 

6 

132 

8.4 

4 

1.6 

2 

.8 

27 

9.8 

30 

9.1 

49 

14.1 

20 

16.4 

7 

75 

4.8 

2 

.8 

5 

2.0 

8 

2.9 

16 

4.8 

34 

9.8 

10 

8.2 

8 

49 
22 
19 
9 
6 
3 
1 
101 

3.1 
1.4 
1.2 

:2 

.2 
.1 

6.4 

1 

.4 

2 

4 

2 

.7 
1.5 
.7 

17 
5 
7 
3 
3 
1 

5.2 
1.5 
2  1 
.9 
.9 
.3 

20 

8 
8 
5 

1 

1 
1 
1 

5.7 
2.3 
2.3 
1.4 
.3 
.3 
.3 
.3 

9 
5 

1 

7  4 

9     

4.1 

10  to  15 

1 
1 

.4 
.4 

8 

10  ..   .. 

11 

1 
1 

.4 
.4 

1 

8 

12     . 

13 

Without  defects 

51 

20.4 

29 

11.8 

13 

4.7 

5 

1.5 

2 

1.6 

Correlations  with  nationality  showed  that  children  ot  foreign-bom 
white  parentage  had  slightly  more  defects  than  those  of  native  white 
parentage. 

The  proportion  without  defect  was  higher  among  children  of  native 
white  mothers  than  among  those  of  the  other  nationality  groups — 6.8 
per  cent  as  compared  with  only  3.6  per  cent  among  the  children  of 
foreign-born  white  mothers  and  2.8  per  cent  among  the  colored 
cliildren.  Among  the  foreign  nationalities  represented  in  the  study 
the  Polish  had  the  largest  proportion  without  defects,  5.4  per  cent, 
the  Magyar  came  next  with  4,  then  the  Slovak  with  3.5  per  cent, 
the  Itahan  with  3.2  per  cent,  the  German  with  2.9  per  cent,  the 
Lithuanian  with  2.4  per  cent,  and  the  Serbo-Croatian  with  only 
1.6  per  cent  free  from  defects.  The  average  number  of  defects  per 
individual  child  among  the  childi-en  w^ho  had  one  or  more  defects 
varied  in  a  similar  manner;  it  was  lowest,  3.8,  for  the  children  of 
native  white  mothers,  next  for  the  children  of  foreign-born  white 
mothers,  averaging  4.3,  and  highest,  4.6.  for  the  colored  cliildren. 
Among  the  foreign  nationalities,  the  Polish  had  the  best  record,  with 
only  3.8  defects  to  a  child;  the  German  were  next,  with  4.1;  the 
Italian  followed,  with  4.3;  the  Slovak  and  Lithuanian,  each  with  4.4, 
the  Serbo-Croatian,  with  4.5;  and  the  Magyar,  w4th  4.6. 

The  proportion  of  children  without  defects  varied  also  according  to 
fathers'  earnings.  Thus  in  families  where  the  fathers  earned  $2,250 
and  over  the  percentage  of  children  without  defects  was  6.6,  as  com- 
pared with  a  percentage  of  only  3.9  in  families  where  the  fathers 
earned  less  than  $1,050. 


32 


PHYSICAL  STATUS  OF   PRESCHOOL  CHILDREN. 


A  discussion  of  the  findings  in  detail  follows,  the  items  covered  by 
the  examination  appearing  in  the  same  order  as  on  the  record  form. 

HEIGHT  AND  WEIGHT. 

The  average  heights  and  weights  of  Gary  boys  and  girls  7  years  of 
age  and  under,  according  to  age,  are  recorded  in  Table  IV.     As  has 

Chart  I.  Average  heights  of  boys  from  birth  to  6  years  of  age;  Children's  year,  Gary,  Gary  and 

health  conferences  combined,  and  Cnun. 
Inches. 

50 


0 


- 

^-. 

:■-'■'■''' 

■:^^' 

. 

^^ 

tff"'''''''^  ^^ 

-  -'*' 

,^ 

''^^' 

*^^ 

^;^ 

;>--•- 

^ 

f" 

f^*^ 

t^TM 

^ 

Zr> 

/" 

/ 

IS 


24 


Months       6  12 

Children's  year 
Gary  health  conferences 
Gary  and  other  health  conferences 
Crum 


36 


48 


54 


60 


66 


72 


already  been  stated,  these  figures  represent  the  results  of  stripped 
examinations,  in  which  measurements  were  made  uniformly  and 
were  carefully  verified.  These  figures  are  lower  tlu'oughout  than 
Crum's  and  Bowditch's,  which  were  used  as  standards  at  the  exami- 
nations, and  also  lower  than  the  averages  obtained  from  the  figures 
submitted  by  doctors  and  nurses  in  all  parts  of  the  country  during 
the  Children's  Year  campaign. 


PHYSICAL,  BINDINGS. 


33 


In  explanation  of  these  differences  it  may  be  noted  that  Doctor 
Crum's  figures  were  based  upon  children  weighed  and  measured  at 
baby  health  conferences  and  baby  contests,  in  many  of  wliich  prizes 
were  given  for  the  most  perfect  physical  development.  The  children 
brought  to  these  conferences  and  contests  undoubtedly  included 
many  who  were  taller  and  heavier  than  the  average.  The  Children's 
Year  figures  were  based  on  a  sample  of  slightly  over  1  per  cent  of  the 

CiiAET  II.  Average  height  of  girls  from  birth  to  6  years  of  age;  Children's  year,  Gary,  Gary  and 

health  conferences  combined,  and  Crum. 
Inches. 
50 


30 


20 


10 


^' 

-^ 

■f^' 

^ 

^•*"' 

^---"' 

,>"■'''' 

m*' 

/ 

y 

<;^ 

5 

18 


24 


Months      6  12 

Children's  years 
Gary  health  conferences 
Gary  and  other  health  conferences 
Orum 


30 


36 


42 


48 


54 


60 


66 


72 


total  number  of  cliildren  under  6  years  of  age  in  the  country,  who 
were  weighed  and  measured  in  the  course  of  the  Childi'en's  Year 
weighing  and  measuring  campaign.  Though  the  campaign  was 
designed  to  reach  all  classes  of  the  population,  the  sample  included 
in  the  tabulation  may  have  been  slightly  biased,  since  the  California 
children,  who  were  foimd  to  be  somewhat  taller  and  heavier  than 
108178°— 22 ^3 


34 


PHYSICAL   STATUS    OF    PRESCHOOL    CHILDREX. 


children  in  other  parts  of  the  country,  were  more  largely  represented 
in  the  group  tabulated  than  in  the  total  population  under  6  years 
of  age. 

The  Gary  heights  and  weights,  however,  as  already  stated,  were 
based  upon  a  very  large  proportion  of  the  children  in  the  city  luider 
6  years  of  age,  and  there  was  therefore  less  chance  for  these  averages 
to  be  influenced  by  any  biased  selections. 

Chart  in.  Average  weights  of  boys  from  birth  to  fi  years  of  age;  Children's  year,  Gary,  Gary 

and  health  conferences  combined,  and  Crum. 
Pounds. 
50 


40 


30 


20 


y 

^ 
,*^'* 

.■_^> 

■J'' 

fJJ'^' 

y^ 

i^'' 

•^ 

^^x' 

A 

/ 

0 
Months       6  12  18  24  30  36 

Childi'en'syear  

Gary  health  conferences  

Gary  and  other  health  conferences 

Crum 


42 


oi 


60 


66 


72 


On  the  other  hand,  the  Gary  averages  are  for  children  in  a  group 
in  which  the  nationality  composition  varies  considerably  from  that 
in  the  country  as  a  whole.  About  three-fifths  of  the  childi-en  under 
7  years  of  age  in  Gary  had  roreign-born  mothers,  as  compared  with 
only  about  one-fourth  in  the  country  as  a  whole.  The  principal 
foreign  nationalities  represented  were  the  Slavic  groups — including 


PHYSICAL   FINDINGS. 


35 


Polish,  Serbo-Croatian,  and  Slovak — and  the  Magyar,  the  Italian, 
and  the  German.  Of  these,  the  Italians  are  of  markedly  shorter 
stature  than  the  British  stocks  which  form  the  principal  element  in 
the  native  white  population,  and  the  Poles  and  Serbs  are  somewhat 
shorter,  wliile  the  Germans  are  of  very  nearly  the  same  stature  as 
the   British   stocks. ^^     The   special   nationality   composition   of   the 

Chakt  I\'.  Average  weights  of  girls  from  birth  to  6  years  of  age;  Children's  year,  Gary,  Gary  and 

health  conferences  combined,  and  Crum. 
Pounds. 

5n 


-c= 

r^"' 

.^' 

--'^^.jr*' 

,. 

-<T$^ 

^ 

-^ 

c^ 

r 

^^ 

■^ 

f 

^7 

f 

A 

w 

J^* 

V 

^ 

f 

/ 

... 

0 
Months      6  12  18  24  30  36  42  48  54  60  66  72 

Children's  year  

Gary  health  conferences  

Gary  and  other  health  conferences 

Crum  — 

Gary  group  of  children  may  therefore  account  for  the  low  average 
heights,  and,  since  at  these  ages  weight  depends  very  largely  upon 
height,  it  may  account  for  the  low  average  weights  also. 

13  For  statistics  as  to  the  average  statures  of  adult  males  of  these  races,  see  The  Medical  Department  of 
the  United  States  Army  in  the  World  War,  Vol.  XV,  Statistics,  Part  I,  Army  Anthropology,  by  Charles 
B.  Davenport  and  Albert  G.  Love,  pp.  17, 113.     Washington,  19'2i. 


36 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN. 


Table  IV. — Average  heights  and  weights,  by  sex  and  age;  white  children  7  years  of  age  and 
under  given  physical  examination.^ 


Age. 


Under  1  month 

1  month,  under  2 

2  months,  under  3... 
H  months,  under  4... 

4  months,  under  5... 

5  months,  under  6. . . 

6  months,  under  7. . . 

7  months,  under  8- .  - 

8  months,  under  9. . . 

9  months,  under  10. . 

10  months,  luider  11. 

11  months,  under  12. 

12  months,  under  13. 

13  months,  under  14. 

14  months,  under  15. 

15  months,  under  16. 

16  months,  under  17. 

17  months,  under  18. 

18  months,  under  19. 

19  months,  under  20. 

20  months,  under  21. 

21  months,  under  22. 

22  months,  under  23. 

23  months,  under  24. 

24  months,  under  27. 
27  months,  under  30. 
30  months,  under  33. 
33  months,  under  36- 
36  months,  under  39. 
39  months,  under  42. 
42  months,  under  45. 
45  months,  under  48. 
48  months,  under  51. 
51  months,  mider  54. 
5-1  months,  under  57. 
57  months,  under  60. 
60  months,  under  63. 
6:5  months,  mider  66. 
66  months,  under  69. 
69  months,  under  70. 
72  months,  under  75. 
75  months,  under  78. 
78  months,  under  81. 
81  months,  under  84. 
84  months,  under  87. 


Boys. 


Numher. 


Average 

height 

(inches). 


21.3 
21.9 
23.3 
24.3 
24.8 
25.7 
25.9 
26.4 
27.0 
27.7 
27.7 
28.4 
28.7 
28.8 
29.7 
29.5 
30.3 
30.8 
31.5 
31.5 
31.5 
32.0 
32.3 
32.7 
33.1 
34.3 
34.8 
35.2 
36.2 
36.9 
37.3 
38.0 
38.2 
39.2 
39.7 
40.3 
41.1 
41.5 
42.1 
43.3 
42.1 
44.0 
44.1 
45.1 
45.1 


Average 

weight 

(pounds) 


10.0 
10.8 
12.3 
13.5 
14.3 
15.9 
16.3 
17.3 
17.8 
19.0 
19.9 
19.8 
19.8 
19.7 
20.4 
20.5 
22.3 
22.2 
23.6 
23.5 
23.4 
24.6 
24.2 
25.3 
2.5.7 
27.1 
28.3 
28.9 
30.1 
31.1 
31.7 
32.7 
33.0 
34.5 
35.5 
36.1 
37.5 
38.2 
39.0 
40.0 
40.9 
42.6 
42.9 
44.2 
45.0 


Girls. 


Number. 


Average 

height 

(inches). 


19.4 
21.3 
22.8 
23.7 
23.9 
24.8 
25.0 
25.9 
26.3 
27.1 
27.4 
27.3 
28.3 
28.4 
28.8 
29.7 
30.  3 
30.0 
30.2 
31.2 
31.6 
31.3 
31.8 
32.2 
32.9 
33.6 
34.4 
35.0 
35.4 
36.7 
36.9 
37.5 
38.4 
39.1 
39.7 
40.5 
40.6 
41.3 
42.0 
42.9 
4.3.1 
43.3 
44.0 
44.4 
45.2 


Average 

weight 

(pounds). 


8.3 
9.5 
11.3 
12.6 
13.3 
14.1 
14.8 
16.2 
16.7 
17.4 
17.1 
18.2 
18.8 
20.3 
18.8 
20.9 
20.9 
21.1 
20.9 
22.0 
22.8 
22.1 
2:3.7 
23.7 
24.6 
25.9 
26.8 
28.4 
28.2 
30.7 
30.2 
31.2 
32.4 
33.5 
35.1 
36.2 
36.4 
36.9 
37.5 
39.8 
40.4 
39.9 
41.8 
42.3 
45.2 


I  Twenty-five  excluded  owing  to  physical  defects. 

NUTRITION. 

In  tiie  absence  of  any  absolute  standard  for  grading  nutrition,  an 
adaptation  of  tiie  Dunfermline  scale  **  was  used  in  distinguishing 
four  grades  of  nutrition,  since,  in  addition,  this  system  implies  the 
types  of  remedial  measures  necessary. 

While  the  Dunfermline  system  takes  into  consideration  the  general 
appearance  of  the  child,  including  the  condition  of  the  skin,  sub- 
cutaneous fat,  muscle  turgor,  anemia,  posture,  vigor,  etc.,  conditions 
all  necessarily  contributory  to  a  complete  picture  of  nutrition,  any 
test  based  upon  individual  observation  and  judgment  would  produce 


»  The  four  groups  are  distinguished  by  the  Dunfermline  scale  as  follows:  1.  "Excellent"  means  the 
nutrition  of  a  healthy  child  "of  good  social  standing."  2.  Children  whose  nutrition  falls  just  short  of 
this  standard  are  "good."  3.  Children  "requiring  supervision"  are  on  the  borderline  of  serious  impair- 
ment.   4.  Children  "r'ecjuiring  medical  treatment"  are  those  whose  nutrition  is  Seriously  impaired. 


PHYSICAL  FINDINGS.  37 

as  great  a  variation  in  results  as  there  were  examiners.  In  this  study, 
therefore,  "grade  of  nutrition,"  as  recorded  for  statistical  purposes, 
was  based  upon  deviations  from  the  average  weight-height  ratios, 
irrespective  of  age.  'Excellent"  included  all  children  above  average 
weight  for  height  whose  general  condition  in  the  opinion  of  the  exam- 
iners was  better  than  ''good."  '"Good"  indicated  that  the  weight 
was  not  under  the  arbitrary  standard  now  in  common  usage,  i.  e.,  10 
per  cent  deviation  below  average  weight  for  height.  '"Poor"  and 
"very  poor"  meant  a  weight-height  ratio  10  per  cent  or  more  below 
average,  and  distinguishable  by  the  attention  required,  "poor"  re- 
quiring supervision  only  and  "very  poor"  indicating  the  need  of 
medical  attention. 

While  the  weight-height  ratio  is  recognized  as  but  a  single  criterion 
in  the  composite  picture  of  nutrition,  and  therefore  in  no  sense  a 
definite  guide,  its  value  as  even  a  rough  index  of  the  general  condi- 
tion of  nutrition  was  tested  in  various  ways  by  the  tabulations  in  this 
study.  The  distribution  of  undernourishment,  thus  graded,  was  de- 
cidedly less  in  this  group  of  children  than  ordinarily  reported — 9.7 
per  cent.  Since  the  care  and  uniformity  with  which  the  heights  and 
weights  were  taken  insure  the  reliability  of  the  figures,  the  question 
is  logically  raised  whether  or  not  the  average  weights  used  as  standard 
in  this  study  are  correct — and  whether  the  10  per  cent  deviation  is 
applicable  to  children  of  these  ages. 

During  the  course  of  the  study,  it  was  frequently  observed  by  the 
medical  examiners  that  a  grade  intermediate  between  "good"  and 
"poor"  was  desirable,  as  a  number  of  children  were  graded  "poor" 
and  others  graded  "good"  because  the  weight-height  index  placed 
them  in  these  groups,  contrar}^  to  the  judgment  and  observation  of 
the  examiners.  With  this  in  mind,  experimental  tabulations  were 
made  to  determine  the  number  and  kinds  of  defects  in  various  weight- 
height  groups,  namely:  (1)  Average  and  above,  (2)  less  than  7  per 
cent  below  the  average/'^  (3)  7  per  cent,  but  less  than  10  per  cent 
below,  and  (4)  10  per  cent  or  more  below. 

The  incidence  of  the  various  kinds  of  defects  as  they  appeared  in 
these  four  weight-deviation  groups  ^^  suggests  that  except  for  anemia 
and  defects  of  the  bony  and  muscular  systems  there  may  be  no  definite 
relation  between  number  and  kinds  of  defects  and  degree  of  under- 
weight. 

These  results  also  make  apparent  the  need  for  further  study  of  the 
growth  of  children  between  2  and  7  years  of  age  before  any  approxi- 
mate standard  of  deviation  from  the  average  weight  can  be  made  for 
children  at  this  age  period.     The  large  proportion  of  defects  among 

1'  Seven  per  cent  deviation  is  apparently  as  arbitrary  a  standard  as  10  per  cent,  but  was  the  figure 
suggested  by  nutrition  workers  at  the  time  this  study  was  in  progress  as  being  a  more  significant  de\'iation 
than  the  commonly  used  10  percent. 

i«  See  General  Table  5,  p.  68. 


38 


PHYSICAL   STATUS    OF    PRESCHOOL    ('HH.nREX, 


children  of  average  weight  or  above  suggests  tlie  importance  of  pe- 
riodic physical  examination. 

Based  on  the  weight-lieight  ratio  alone,  Table  V  indicates  that  at 
least  an  average  condition  of  nutrition  (good  and  excellent)  was  found 
in  90.3  per  cent  of  the  group,  although  only  18.6  per  cent  were  con- 
sidered "excellent." 

Boys  varied  from  the  average  less  than  girls;  of  the  latter  20.4  per 
cent  were  found  in  the  "excellent"  grade  and  10.4  per  cent  in  the 
malnourished  group  (poor  and  very  poor  combined)  in  contrast 
with  the  comparative  percentages  of  16.7  and  9,  among  the  boys. 

Table  V. — Grade  of  nutrition,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination. 


Age  and  sex. 


Both  sexes 

2  years,  under  3 . 

3  years,  under  4 . 

4  years,  under  ,'> . 

5  years,  under  6. 

6  years,  under  7 . 

7  years,  under  8 . 

Boys 

2  years,  under  3 . 

3  years,  under  4. 

4  years,  under  5. 

5  years,  under  6. 

6  years,  under  7. 

7  years,  under  8. 

Girls 

2  years,  under  3 . 

3  years,  under  4. 

4  years,  under  5 . 

5  years,  under  6 . 

6  years,  under  7. 

7  years,  under  8. 


Total 
chil- 
dren. 


511 
496 
549 
667 
682 
220 

1,555 


261 
251 
274 
337 
334 


1,570 


250 
245 
275 
330 
348 
122 


Grade  of  nutrition. 


Excelllent. 


Num- 
ber. 


71 

S8 
100 
126 
142 

53 

259 


Per 
pent. 


18.6 


13.9 
17.7 
18.2 
18.9 
20.8 
24.1 

16.7 


13.4 
16.7 
15.3 
16.9 
18.  C 
21.4 

20.4 


14.4 

18.8 
21.1 
20.9 
23.0 
26.2 


Good. 


Num- 
ber. 


2,242 


355 
349 
393 
497 
492 
156 

1,156 


183 
ISO 
204 
264 
252 
73 


Per 

cent. 


71.7 


69.5 
70.4 
71.6 
74.5 
72.1 
70.9 

74.3 


70.1 
71.7 
74.5 
78.3 
75.4 
74.5 


1,086       69.2 


172 

169 
189 
233 
240 

83 


69.0 
68.7 
70.6 
69.0 
68.0 


Poor. 


Num- 
ber. 


Per 

cent. 


15.9 
11.5 
9.8 
6.1 
5.9 
3.6 


15.3 
11.2 
9.9 
4.7 
5.1 
2.0 


16.4 
11.8 
9.8 
7.6 
6.6 
4.9 


Very  poor. 


Num-      Per 
ber.      cent. 


0.7 


.8 
.4 
.4 
.4 
1.'2 
1.4 


1.1 
.4 
.4 


.4 
.4 
.4 
.9 
1.4 


Classified  according  to  nationality,  the  well  nourished  showed  an 
equal  distribution  among  children  of  native  and  of  foreign-born  white 
parentage,  although  the  former  group  had  a  slightly  higher  per  cent 
of  "  excellently"  nourished — 20.9  as  against  17.  The  highest  per  cent 
of  "excellently  nourished"  in  any  nationality  appeared  in  the  Lithu- 
anians (28.9),  and  the  highest  per  cent  of  poorly  nourished  appeared 
in  the  Germans  (15.1) .  Colored  children  showed  an  average  condition 
regarding  nutrition. 

The  higher  income  groups  contained  20.5  per  cent  excellently  nour- 
ished children  and  9.4  per  cent  poorly  nourished.  The  lower  income 
groups  contained  16.7  per  cent  excellently  nourished  and  10  per  cent 
poorly  nourished — indicating  that  higher  family  incomes  do  not  nec- 
essarily imply  more  intelligent  feeding  and  care. 


PHYSICAL   FINDINGS. 


39 


Table  VI. — Grade  of  nutrition,  by  color  and  nationality  of  mother;  children  2  to  7  years 
of  age  given  physical  examination. 


Total 
chil- 
dren. 

Grade  of 

lutrition. 

Color  and  nationality  of  mother. 

Excellenl. 

Good. 

Poor. 

Very  poor. 

Num- 
ber. 

Per 
cent.i 

Num- 
ber. 

Per 

cent.i 

Num- 
ber. 

Per 

cent.i 

Num- 
ber. 

Per 
cent.i 

Total 

3,125 

580 

18.6 

2,242 

71.7 

281 

9.0 

22 

0.7 

White 

3,047 

1,151 

1,896 

321 

313 

224 

176 

157 

139 

S3 

483 

71 

7 

563 
240 
323 
58 
36 
29 
34 
33 
27 
24 
82 
15 
2 

18.5 
20.9 
17.0 
18.1 
11.5 
12  9 
19.3 
21.0 
19.4 
28.9 
17.0 
21.1 

2,188 

797 

1,.391 

235 

243 

172 

131 

115 

91 

53 

351 

49 

5 

71.8 
69.2 
73.4 
73.2 
77.6 
76.8 
74.4 
73.2 
65.5 
63.9 
72.7 
69.0 

274 

106 

168 

26 

29 

21 

11 

9 

20 

6 

46 

7 

9.0 
9.2 
8.9 
8.1 
9.3 
9.4 
6.3 
5.7 
14.4 
7.2 
9.5 
9.9 

22 
8 

14 
2 
5 
2 

.7 

.7 

.7 

Serbo-Croatian 

6 

Slovak 

1.6 

Polish 

.9 

Magyar 

German 

1 

.7 

Lithuanian 

All  other 

4 

.8 

Not  reported 

1  Not  shown  where  base  is  less  than  50. 


Table  VII. — Grade  of  nutrition,  by  earnings  of  chief  breadwinner;  children  2  to  7  years 
of  age  given  physical  examination. 


Earnings  of  chief  breadwinner. 


Total 
chil- 
drin. 


Grade  of  nutrition. 


Excellent. 


Num- 
ber. 


Per 
cent. 


Good. 


Num- 
ber. 


Per 
cent. 


Poor. 


Num- 
ber. 


Per 

cent. 


Very  poor. 


Num- 
ber. 


Per 

cent. 


Total 

Under  $050 

$650-8849 

$850-$l,049 

$l,0o0-$l,249 

$1,250-$1,449 

$1,450-$1,849 

$1,850-82,249 

$2,250  and  over 

No    chief   breadwinner    and   no 

earnings 

Not  reported 


580 


18.6 


71.7 


9.0 


110 
240 
412 
491 
456 
613 
262 
.303 

58 
180 


11 

36 
.56 
94 
88 
121 
53 
68 

11 

42 


10.0 
15.0 
13.6 
19.1 
19.3 
19.7 
20.2 
22.4 

19.0 
2S.3 


179 
317 
342 
326 
430 
183 
212 

42 
122 


80.9 
74.6 
76.9 
69.7 
71.5 
70.1 
69.8 
70.0 

72.4 
67.8 


8.2 
8.3 
8.3 
10.8 
8.6 
9.8 
9.2 
7.3 

8.6 
8.3 


22 


.9 
2.1 
1.2 
.4 
.7 
.3 


ANEMIA. 

Obviously,  mere  inspection  of  the  mucous  membranes  for  pallor 
furnishes  no  accurate  guide  as  to  the  degree  of  anemia;  but  in  this 
type  of  study  blood  examinations  are  not  feasible.  However,  the 
results  here  recorded  coincide  somewhat  closely  with  those  of  more 
accurate  clinical  methods. 

Nearly  8  per  cent  of  the  group  were  considered  anemic.  There 
was  very  slight  difference  in  this  respect  between  boys  and  girls,  but 
pallor  was  more  common  in  the  older  children.  In  both  sexes  a  very 
notable  increase  in  the  percentage  of  pale  children  appeared  after 


40 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN. 


the  fifth  year,  and  a  marked  increase  during  the  seventh  year,  when 
16,7  per  cent  showed  unusual  pallor. 

The  percentage  of  anemic  children  was  slightly  liigher  among  the 
children  of  foreign-born  parentage  (8.G)  than  among  those  of  native 
white  parentage  (6.2).  The  colored  children  showed  the  highest 
percentage  (11.3). 

Children  in  the  families  of  income  groups  below  $1,450  showed  a 
slightly  higher  percentage  of  anemia  (8.4)  than  children  in  the 
families  of  the  groups  where  earnings  were  SI, 450  and  over  (6.5). 

While  pallor  is  generally  considered  a  fairly  constant  sign  in  malnu- 
trition, in  this  study  only  13.9  per  cent  of  the  most  seriously  under- 
weight children  were  considered  anemic. 

VACCINATION. 

Unless  the  mother  was  with  the  child,  no  history  as  to  age  or 
success  of  smallpox  vaccination  was  obtainable,  and  the  presence  of 
a  scar  was  the  evidence  on  which  vaccination  was  checked. 


Table  VIIL- 


■  Vaccination,  by  age  and  sex;  children  2  to 
examination. 


years  of  age  given  physical 


Age  and  sex. 


Total 
children. 


Vaccinated. 


Number.  Per  cent 


Not  vaccinated. 


Number.   Per  cent. 


Not 
reported 
whecher 
vacci- 
nated. 


Both  sexes 

2  years,  under  3. 

3  years,  under  4 . 

4  years,  under  5. 

5  years,  under  6. 

6  years,  under?. 

7  years,  under  8. 

Boys 

2  years,  under  3. 

3  years,  under  4 . 

4  years,  under  5. 

5  years,  under  6 . 

6  years,  under  7. 

7  years,  under  8 . 

Girls 

2  years,  under  3. 

3  years,  imder  4 . 

4  years,  under  .'> . 

5  years,  under  6 . 

6  years,  imder  7 . 

7  years,  under  8. 


3,125 


511 
496 
.549 
667 
682 
220 

1,555 


261 
251 
274 
337 
«34 


1,570 


250 
245 
275 
330 
348 
122 


762 


44 
75 
111 
195 
253 
84 

368 


23 
34 
48 
101 
126 
36 

394 


21 
41 
63 

94 
127 

48 


24.4 


8.6 
15.1 
20.2 
29.2 
37.1 
38.2 

23.7 


467 
421 
436 
470 
428 
136 

1,184 


8.8 
13.5 
17.5 
30.0 
37.7 
36.7 

2.5.1 


238 
217 
225 
234 
208 
62 

1,174 


8.4 
16.7 
22.9 
28.5 
36.5 
39.3 


229 
204 
211 
236 
220 
74 


75.5 


91.4 
84.9 
79.4 
70.5 
62.8 
61.8 

76.1 


91.2 
86.5 
82.1 
69.4 
62.3 
63.3 

74.8 


91.6 
83.3 

76.7 
71.5 
63.2 
60.7 


Of  all  the  children  examined,  only  24.4  per  cent  had  been  vacci- 
nated. Early  vaccination,  i.  e.,  by  1  year  of  age,  appears  not  to 
have  been  the  rule,  for  only  8.6  per  cent  of  the  children  between 
2  and  3  years  of  age  had  been  vaccinated.  The  percentage  increased 
with  each  year  of  age,  however,  and  reached  37.1  by  the  seventh  year, 
indicating   that   the  school-entrance  requirement  was  the  principal 


PHYSICAL   FINDINGS. 


41 


factor  influencing  vaccination.  About  one-sixth  (14.6  per  cent)  of 
the  1,581  cliildren  who  had  not  entered  scliool  had  been  vaccinated, 
while  of  the  1,544  attending  school  more  than  one-third  (34.4  per 
cent)  liad  been  vaccinated. 

Table  IX. — Vaccination,   time  of  vaccination,   and  entrance  in  school,   by  color  and 
nationality  of  mother;  children  2  to  7  years  of  age  given  physical  examination. 


Children  of  - 

Vaccination,  time  of  vaccination,  and 

Total 
children. 

Native  white 
mothers. 

Foreign-born 

white 

mothers. 

Negro 
mothers. 

Moth- 
ers 

whose 
na- 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 

cent 

dis 

tribu- 

tion. 

Num- 
ber. 

Per 

cent 
dis- 
tribu- 
tion. 

tion- 
ality 
was 
not  re- 
port- 
ed. 

Total               

3,125 

100.0 

1, 1.51 

100.0 

1,896 

100.0 

71 

100.0 

7 

Not  vet  in  school 

1  581       .t(1.  fi 

596 
56 
540 

51.8 
4.9 
46.9 

949 

175 

772 

2 

947 

374 

99 

33 

242 

570 

3 

50.1 

9.2 

40.7 

.1 

49.9 

19.7 

5.2 

1.7 

12.8 

30.1 

.2 

32 

45.1 

4 

Vaccinated 

231 

1,348 

2 

1,544 

531 

142 

71 

318 

1,010 

3 

7.4 

43.1 

.1 

49.4 

17.0 

4.5 

2.3 

10.2 

32.3 

.1 

Not  vaccinated.        .      .      .  . 

32 

45.1 

4 

Not  reported 

In  school . . 

555 
149 
40 
36 
73 
406 

48.2 
12.9 
3.5 
3.1 
6.3 
35.3 

39 
7 
2 
2 
3 

32 

54.9 
9.9 
2.8 
2.8 
4.2 

45.1 

3 

1 

Before  entering  school 

After  entering  school 

1 

Not  vaccinated . . 

2 

Vaccination  not  reported 

A  comparison  by  nationality  shows  that  28.9  per  cent  of  the  chil- 
dren of  foreign-born  white  mothers  and  17.8  per  cent  of  those  of 
native  white  mothers  had  been  vaccinated. 

It  was  impossible  to  get  entirely  accurate  figures  as  to  how  many 
of  the  school  children  were  vaccinated  before  and  after  entering 
school,  on  account  of  the  large  number  of  cases  in  which  no  report  on 
this  subject  was  made.  However,  an  analysis  of  the  few  cases  where 
an  answer  to  this  question  was  obtained  revealed  the  fact  that 
among  132  children  of  foreign-born  white  parentage,  tliree  times  as 
many  were  vaccinated  before  entering  school  as  after  entering,  99 
as  compared  with  33;  while  among  76  children  of  native  white 
parentage,  almost  as  many  were  vaccinated  after  entering  school  as 
before  entering,  36  as  compared  with  40. 

The  fact  that  in  the  mother  countries  people  are  accustomed  to 

compulsory  vaccination  probably  accounts  for  the  greater  frequency 

and  earlier  ages  of  vaccination  among  the  children  of  foreign-born 

parentage. 

HEAD. 

While  anthropometric  head  measurements  were  not  made  in  this 
study,  observations  were  recorded  as  to  apparent  abnormalities  in 
size  in  76  cases.  More  than  twice  as  many  boys  as  girls  had  abnor- 
mally shaped  heads,  the  square  or  rachitic  head  being  the  most  preva- 


42 


PHYSTCAI.   STATUS   OF   PRESCHOOL   CHILDREN. 


lent  type.     Open  fontanelles  ranging  in  diameter  from  1  centimeter 

to  2^  centimeters  persisted  in   13  children  in  this  group,  of  whom 

one  was  past  8  years  of  age. 

EYES. 

It  was  possible  to  test  vision  in  only  about  two-thirds  (2,044  cases) 
of  the  children  who  were  given  physical  examinations,  since  only  the 
exceptional  child  under  3  years  of  age  comprehended  the  test  at  all 
and  only  a  very  small  number  (124)  of  children  under  4  years  did  so. 

Out  of  the  2,044  children  given  vision  tests,  slightly  more  than 
one-third  (36.1  per  cent)  showed  defective  sight  of  varying  degree, 
with  apparently  no  significant  relation  to  age,  although  the  fifth 
year  showed  a  slightly  higher  per  cent  than  any  of  the  others  (39) . 

Table  X. — Defect  of  vision,  by  age;  children  2tol  years  of  age  given  physical  examination. 


Total 
children. 

2 

years, 

under 

3.1 

3  years,         4  years, 
under  4.         under  5. 

5  years, 
under  6. 

6  years, 
under  7. 

7  years, 
under  8. 

Defect  of  vision. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Nimi- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Total 

3, 125 

511 

496 

549 

667 

6S2 

220 

Vision  tested 

Vision  normal 

Vision  defective. .  . 
Both  slightly  de- 

2,044 
1,306 

738 

461 
108 

76 

29 

61 

3 
1,0S1 

100.0 
63.9 
36.1 

22.6 

5.3 

3.7 

1.4 

3.0 
.1 

4 
3 

1 

1 

124 

85 
39 

29 

3 

3 

100.0 
68.5 
31.5 

23.4 

2.4 

2.4 

403 
248 
155 

101 

IS 

20 

4 

12 
"146' 

100.0 
61.5 
38.5 

25.1 

4.5 

5.0 

1.0 

3.0 

631 
385 
246 

163 

32 

22 

6 

22 
1 

100.0 
Gl.O 
39.0 

25.8 

5.1 

3.5 

1.0 

3.5 
.2 

663 
414 
249 

142 

44 

27 

16 

19 

100.0 
62.4 
37.6 

21.4 

6.6 

4.1 

2.4 

1  Q 

219 
171 

48 

25 
11 

4 

3 

5 

100.0 
78.1 
21.9 

11.4 

Both     seriously 
defective 

One  normal,  one 
sUghtly  defec- 
tive  

5.0 
1.8 

One  normal,  one 
seriously     de- 
fective  

1.4 

One  slightly  de- 
fective,   other 
seriously     de- 
fective. 

"sof 

3 

1 
372 

2.4 

.8 

2.3 

Blind  in  one  or 

both  eyes 

Vision  not  tested 

1         -2 

36 

19 

1 

I  Per  cent  distribution  not  shown  where  base  is  less  than  50. 

The  degree  of  visual  abnormality  varied  from  slight  defect  of  one 
eye  to  serious  defect  of  one  or  both,  and  even  blindness. 

In  108  cases  vision  was  seriously  defective  in  both  eyes  and  the 
need  for  glasses  imperative,  as  shown  by  the  test  and  corroborated 
by  the  specialist.  Of  these  children,  only  10  per  cent  were  wearing 
glasses;  the  other  90  per  cent  were  not  even  cognizant  of  the  need 
for  them. 

Strabismus  was  found  m  2.4  per  cent  of  all  the  children,  but  cor- 
rective glasses  for  this  defect  were  being  worn  by  only  about  one- 
seventh  of  the  children  Avith  this  defect.  While  fewer  boys  (33)  than 
girls  (43)  had  strabismus,  it  is  worthy  of  comment  that  of  the  11 
children  having  strabismus  and  wearing  glasses  only  1  was  a  boy. 


PHYSICAL   FINDINGS. 


43 


E_ye  diseases  and  defects  other  than  those  of  vision  were  found  in 
7.8  per  cent  of  all  the  children;  but  twice  as  large  a  proportion  of 
those  with  poor  vision  (12.6  per  ami)  as  of  those  with  normal  vision 
(6.4  per  cent)  had  other  eye  defects  or  diseases. 

Table  XI. —  Vision,  by  sr.r  and  eye  diseuite  or  other  defect;  children  2  to  7  years  of  age 
given  physical  examination. 


Vision  and  sex. 

Total 
children. 

With  eye  disease  or 

defect  other  than 

vision. 

Without 

eye 
disease. 

Number. 

Percent. 

3,125 

245 

7.8 

2,880 

Vision  tested                                                 .             

2,044 

1,306 

738 

1,081 

1,555 

177 

84 
93 
68 

127 

8.7 
6.4 
12.6 
6.3 

8.2 

1,867 

1,222 

645 

1,013 

1,428 

998 
643 
355 
557 

1,570 

91 

46 
45 
36 

118 

9.1 
7.2 
12.7 
6.5 

7.5 

907 

Normal 

697 

310 

521 

Girls 

1,452 

Vision  tested 

1,046 
663 
383 
524 

86 
38 

48 
32 

8.2 
5.7 
12.5 
6.1 

960 

Normal 

625 

335 

492 

On  the  whole,  slight  difference  was  found  between  the  eye  con- 
ditions of  the  children  of  native  and  of  foreign-born  white  parentage. 
Among  the  latter,  the  highest  percentage  with  defective  vision  was 
found  among  the  children  of  Italian  parentage.  The  colored  children, 
although  few  in  number,  were  freer  from  eye  defects  than  any  other 
group  of  children,  only  1  out  of  71  (1.4  per  cent)  having  eye  defect. 

Table  XII. — Eye  disease  or  defect  other  than  of  vision,   by  color  and  nationality  of 
mother;  children  2  to  7  years  of  age  given  physical  examination. 


Color  and  nationality  of  mother. 


Total 
children. 


With  eye  disease 
or  defect  other 
than  of  vision. 


Nimiber.   Per  cent 


Without 

eye 
disease. 


Total. 


White 

Native 

Foreign-born 

Serbo-Croatian . 

Slovak 

PoUsh 

Magyar 

Italian 

German 

Lithuanian 

AH  other 

Negro 

Not  reported 


3,125 


3,047 

1,151 

1,896 

321 

313 

224 

176 

157 

139 

83 

483 

71 

7 


245 


244 
86 

158 
27 
32 

n 

17 
19 
11 

4 
35 

1 


7.8 


8.0 
7.5 
8.3 
8.4 

10.2 
5.8 
9.7 

12.1 
7.9 
4.8 
7.2 
1.4 


2,880 


2,803 

1,065 

1,738 

294 

281 

211 

159 

138 

128 

79 

448 

70 

7 


44 


PHYSICAL  STATUS  OF   PRESCHOOL  CHILDREN. 


EARS. 

It  was  not  possible  to  test  successfully  as  many  children  for  hear- 
ing as  for  ^dsion,  as  sufficiently  quiet  quarters  could  not  always  be 
obtained.  The  total  number  examined  was  about  200  less  than  the 
number  tested  for  vision.  The  total  number  of  cases  of  defective 
hearing,  including  slight  and  serious  defect  of  one  or  both  ears,  was 
only  25,  or  1.4  per  cent  of  those  examined. 

Aside  from  defective  hearing,  the  other  ear  defects  noted  were  25 
cases  of  otorrhea  and  258  cases  of  retracted  ear  drums. 

MOUTH. 

Teeth. 

The  most  conspicuous  single  defect  in  the  entire  preschool  group 
was  carious  teeth.  This  condition  was  found  in  64.7  per  cent  of  the 
children  examined,  the  percentages  increasing  from  21.1  in  the  2-  to 
3-year-old  children  to  87. 7  in  the  6-  to  7-year-olds.  In  the  entire 
group,  83  children  had  decayed  permanent  teeth. 


Table  XIII. — Decayed  teetJi,  6y  age  and  sex;  children  2  to 

examination. 


years  of  age  given  physical 


Total 
chil- 
dren. 

With  decayed  teeth. 

Age  and  sex 

decayed 
teeth. 

Total. 

Temporary 
only. 

Temporary 

and 
permanent. 

Permanent 
only. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Both  sexes 

3,125 

1  104 

.^=;.  3 

2,021 

64.7 

1,938 

r2.o 

80 

2.6 

3 

0.1 

2  years,  under  3 

511 
49P 
549 
607 
6S2 
220 

1,555 

403 
278 
185 
134 
84 
20 

548 

78.9 
56.0 
33.7 
20.1 
12.3 
9.1 

35.2 

108 
218 
364 
533 
598 
200 

1,007 

21.1 
44.0 
66. 3 
79.9 
87.7 
90.9 

64.8 

108 
218 
363 
520 
555 
174 

976 

21.1 
44.0 
66. 1 
78.0 
81.4 
79.1 

62.8 

...  i 

3  years,  under  4 

4  years,  under  5 

1 

13 
41 
25 

.2 
1.9 
6.0 
11.4 

6  years,  under  7 

2 
1 

.3 

7  years,  under  8 

Boys 

31       2.0 

2G1 
251 
274 
337 
334 
98 

1,570 

204 
136 
92 
64 
41 
11 

556 

78.2 
54.2 
33.6 
19.0 
12.3 
11.2 

35.4 

57 
115 
182 
273 
293 

87 

1,014 

21.8 
45.8 
66. 4 
81.0 
87.7 
88.8 

64.6 

57 
115 
181 
266 
279 

78 

962 

21.8 
45.8 
66. 1 
78.9 
83.5 
79.6 

61.3 

3  years,  under  4  . 

4  years,  under  5 

1         .4 

7 
14 
9 

49 

2.1 
4.2 
9.2 

3.1 

7  yearS;  under  8 

Girls 

3 

.2 

2  years,  under  3 

250 
245 
275 
330 
348 
122 

199 
142 
93 
70 
43 
9 

79.6 
58.0 
33.8 
21.2 
12.4 
7.4 

51 
103 
182 
2G0 
305 
113 

20.4 
42.0 
6(i.  2 
78.8 
87.6 
92.6 

51 
103 
182 
254 
276 

96 

20.4 
42.0 

oi,;.  2 

77.0 
79.3 

78.7 

6 
27 
16 

1.8 
7.8 
13.1 

6  years,  under  7 

2 

1 

.6 

.8 

Information  regarding  previous  dental  attention  showed  that  only 
3.2  per  cent  had  had  any  teeth  filled,  such  a  very  small  proportion 
at  once  indicating  ignorance  regarding  the  importance  of  dental 
attention  for  temporary  teeth.    One  child  under  3  years  of  age  had  a 


PHYSICAL.  FINDINGS. 


45 


filled  tooth,  but  108  between  2  and  3  years  had  decayed  teeth  which 
had  not  been  filled.  The  lack  of  dental  care  was  almost  as  serious 
among  the  older  children,  95  per  cent  of  those  between  6  and  7 
with  decayed  teeth  having  received  no  attention  whatever. 

Other  mouth  defects. 

Gum  abscesses  and  malocclusion  were  the  other  most  frequent 

mouth  defects,  3.2  per  cent  showing  the  former  and  11  per  cent  the 

latter  defect.     Malocclusion  showed  only  slight  variations  by  sex, 

but  a  decided  increase  with  age,  especially  marked  after  the  fifth 

year.    This  defect  was  found  to  occur  approximately  three  times  as 

often  among  children  with  positive  diagnosis  of  adenoids  as  among 

others. 

NASOPHARYNX. 

Defects  of  the  nasopharynx  were  the  most  common  type  of  defect 
noted  in  this  preschool  group,  occurring  in  69  per  cent  of  all  cases, 
while  the  defects  of  the  mouth  claimed  second  place  with  66.9  per 
cent.  On  the  whole  there  was  a  slightly  higher  per  cent  of  boys  with 
nasopharyngeal  defects  than  of  girls,  71.9  and  66.2  per  cent,  respec- 
tively. The  highest  per  cent  of  nasopharyngeal  defects  for  both 
sexes  (78.1  per  cent)  appeared  in  the  sixth  year. 

Table  XIV. — Nasopharyngeal  defect,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination. 


Total  children. 

2  years,  under  3.^3  years,  under  4. 

1 

4  years,  under  5 

Nasopharyngeal  defect,  and  sex. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Num- 
ber. 

Per 

cent 
distri- 
bution. 

Num- 
ber. 

Per 

cent 
distri- 
bution. 

Both  sexes 

3,125 

100.0 

511 

100.0 

496 

100.0 

549 

100.0 

With  nasophai'viigeal  defect 

2,157 
711 
342 
915 
179 
10 
968 

1,555 

69.0 
22.8 
10.9 
29.3 
5.7 
.3 
31.0 

100.0 

250 
154 
19 

49 

27 

1 

261 

261 

48.9 

30.1 

3.7 

9.6 

5.3 

.2 

51.1 

100.O 

312 
165 
34 

89 

23 

1 

184 

251 

62.9 
33.3 

6.9 
17.9 

4.6 

.2 

37.1 

100.0 

395 
165 

54 
154 

21 

1 

154 

274 

71.9 

30.1 

Adenoids  only     

9.8 

Defective  tonsils  with  adenoids. . . 
High-arch  palate  onlv 

28.1 
3.8 

Other  nasopliaryngeal  defect 

Without  nasopharyngeal  defect 

.2 

28.1 

loao 

With  nasopharyngeal  defect 

1,118 
348 
188 
488 
91 
3 
437 

1,570 

71.9 
22.4 
12.1 
31.4 
5.9 
.2 
28.1 

100.0 

135 
79 
10 
31 
15 

51.7 
30.3 

3.8 
11.9 

5.7 

166 
83 
20 
49 
13 
1 
85 

245 

66.1 
33.1 

8.0 
19.5 

5.2 

.4 

33.9 

100.0 

199 
81 
27 
82 
9 

72.6 

29.6 

Adenoids  only 

9.9 

Defective  tonsils  with  adenoids. . . 
High-arch  palate  only 

29.9 
3.3 

other  nasopharyngeal  defect 

Without  nasopharyngeal  defect 

Girls 

126 
250 

48.3 
100.0 

75 

275 

27.4 
100.0 

With  nasopharyngeal  defect  . 

1,039 
363 
154 

427 

88 

7 

5:jl 

66.2 
23.1 

9.8 
27.2 

5.6 

.4 

33.8 

115 

75 
9 
18 
12 

1 
135 

46.0 

30.0 

3.6 

7.2 

4.8 

.4 

54.0 

146 
82 
14 
40 
10 

59.6 
33.5 

5.7 
16.3 

4.1 

196 
84 
27 
72 
12 
1 

71.3 

Defective  tonsils  only 

30.5 

Adenoids  only 

9.8 

Defective  tonsils  with  adenoids. . . 

26.2 
4.4 

other  nasopharyngeal  defect 

Without  nasopharyngeal  defect 

.4 

99 

40.4 

79 

28.7 

46 


PHYSICAL  STATUS   OF   PRESCHOOL   CHILDREN. 


Table  XIV. — Nasopharyngeal  defect,  hy  age  and  sex;  children 
physical  exam  ination — Concluded . 


to  7  years  of  age  given 


Nasopliaryngeal  defect,  and  sex. 


Both  sexes . 


5years,under6. 


Per 
Num-      cent 
ber.      distri- 
bution. 


667 


With  nasopharjTigeal  defect j      521 


111 
97 
268 
42 
,5 
Without  nasopharyngeal  defect '      1-16 


Defective  tonsUs  only. 

Adenoids  only 

Defective  tonsils  with  adenoids. 

High-arch  palate  only 

Other  nasopharyngeal  defect. 


Boys. 


100.0 


6  years,  under  7. 


Num- 
ber. 


6S2 


Per 
cent 
distri- 
bution. 


7  years,  under  8. 


Num- 
ber. 


100.0 


220 


Per 
cent 
distri- 
bution. 


100.0 


78.1 
16.6 
14.0 
39.9 
6.3 
.7 
21.9 

100.0 


517 
82 

106 

283 
44 
2 

165 


With  nasopharyngeal  defect 274 

Defective  tonsils  only 

Adenoids  only 

Defective  tonsils  with  adenoids 

High-arch  palate  only 

Other  nasopharjnigeal  defect 

Without  nasopharyngeal  defect 


Girls. 


45 
53 
153 
22 
1 
63 

330 


81.3 
13.4 
15.7 
45.4 
6.5 
.3 
18.7 

100.0 


With  nasopharyngeal  defect -  -  247 

Defective  tonsils  only j  66 

Adenoids  only i  44 

Defective  tonsils  with  adenoids j  113 

High-arch  palate  only '  20 

Other  nasophar>-ngeal  defect !  4 

With  nasopha^}^lgeal  defect I  83 


74.8 
20.0 
13.3 
34.2 
6.1 
1.2 
25.2 


268 
40 
62 

143 

22 

1 

66 

348 


249 
42- 
44 

140 

22 

1 


75.8 
12.0 
15.5 
41.5 
6.5 
.3 
24.2 

100.0 


80.2 
12.0 
18.6 
42.8 
6.6 
.3 
19.8 

100.0 


71.6 
12.1 
12.6 
40.2 
6.3 
.3 
28.4 


162 
34 
32 
74 
22 


58 


73.6 
15.5 
14.5 
33.6 
10.0 


26.4 
100.0 


22 

122 


77.6 
20.4 
16.3 
30.6 
10.2 


22.4 
100.0 


70.5 
11.5 
13.1 
36.1 
9.8 


29.5 


Adenoids. 

Adenoids  were  definitely  diagnosed  in  one-third  (33.6  per  cent) 
of  all  cliildren  examined,  while  an  additional  6.6  per  cent  were  con- 
sidered as  probably  having  adenoids,  this  being  indicated  by  the 
presence  of  one  or  more  suggestive  signs,  viz.,  mouth  breathing,  nasal 
discharge  vdih  excoriation  of  the  nares,  high-arch  palate,  adenoid 
facies,  etc. 

Table  XV.— Adenoid  condition,  by  age  and  sexj  children  2tol  years  of  age  given  physical 

examination. 


Total  children. 

2  years,  under  3. 

3 years,  under 4. 

4years,undcr5. 

Adenoid  condition,  and  sex. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Num- 
ber. 

Per 
cent 
distri- 
bution. 

Both  sexes 

3,125 

100.0 

511        100. 0 

496 

100.0 

549 

100.0 

1,050          33.6 

207            6. 6 

1,868          59.8 

1,555         100.0 

34 

34 

443 

261 

6.7 
6.7 
86.7 

100.0 

76 
47 
373 

251 

15.3 
9.5 
75.2 

100.0 

164 
44 
341 

274 

29.9 

s.o 

62.1 

Boys 

100.0 

570 

36.7 

18            6.9 
23            8.8 
220          84.3 

250         100.0 

42 

27 
1S2 

245 

16.7 
10.8 
72.5 

100.0 

S8 
21 
IGo 

275 

32.1 

106 
879 

1,570 

6.8 
56.5 

100.0 

>.  / 

60.2 

Girls 

100.0 

480 
101 
989 

30.6 
6.4 
63.0 

16 

11 

223 

6.4 
4.4 

89.2 

34 
20 
191 

13.9 

8.2 
78.0 

76 
23 
170 

27.6 

With  adenoids  (suspected  i 

&4 

64.0 

PHYSICAL  FINDINGS. 


47 


Table  XV. — Adenoid  condition,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination — Concluded . 


Adenoid  condition,  and  sex. 


Both  sexes 

With  adenoids  (definite) . . 
With  adenoids  (suspected) 
Without  adenoids 

Boys 

With  adenoids  (definite) . . 
With  adenoids  (suspected) 
Without  adenoids 

Girls 

With  adenoids  (definite) . . 
With  adenoids  (suspected) 
Without  adenoids 


5  years,  under  6. 


Num- 
ber. 


315 

48 
304 

337 


187 
19 
131 


128 
29 
173 


Per 
cent 
distri- 
bution. 


100.0 


47.2 

7.2 

45.6 

100. 0 


55.5 
5.6 
38.9 

100.0 


6  years,  under  7. 


Num- 
ber. 


361 
28 
293 


191 
14 
129 

348 


170 
14 
164 


Per 
cent 
distri- 
bution. 


52.9 

4.1 

43.0 


57.2 
4.2 
38.6 

100.0 


48.9 

4.0 

47.1 


7  years,  under  8. 


Num- 
ber. 


220 


100 

6 

114 


Per 
cent 

distri. 

button. 


100.0 


45.5 

2.7 

51.8 

100.0 


44.9 

2.0 

5.3.1 


4.'5.9 
3.3 
.50.8 


Adenoids  were  more  prevalent  among  boys,  throughout  all  the  pre- 
school years.  Only  6.7  per  cent  of  the  children  under  3  years  of  age 
had  adenoids  definitely  diagnosed  and  an  equal  number  had  "sus- 
pected" ones.  The  number  of  cases  of  positively  diagnosed  adenoids 
increased  with  age,  reaching  a  maximum  of  52.9  during  the  seventh 
year,  while  the  maximum  in  "suspected"  cases  was  reached  during 
the  fourth  year.  Whether  adenoids  are  often  present  in  younger 
children,  and,  if  present,  whether  they  are  of  such  slow  growth  that 
their  effects  are  not  manifested  by  symptoms  until  the  sixth  or  seventh 
year,  is  a  question  inviting  further  observation  and  scientific  investi- 
gation. 

Only  insignificant  differences  in  the  prevalence  of  adenoids  betw^een 
the  children  of  native  and  of  foreign-born  white  mothers  were  found, 
the  percentages  being  34.3  and  33.8,  respectively.  The  highest  per 
cent  of  adenoids  (41)  was  found  in  the  children  of  German  parentage, 
the  lowest  per  cent  (19.7)  in  the  colored  children. 

Symptoms  suggesting  adenoids. 

(a)  Mouth  hreatliing.—Oi  the  entire  group  of  children  examined, 
39.4  per  cent  were  mouth  breathers.  Mouth  breathing  proved  a 
remarkably  constant  symptom  of  adenoids,  being  present  in  99.6 
per  cent  of  the  cases.  Only  four  cases  of  adenoids  in  which  the 
child  was  apparently  not  a  mouth  breather  were  recorded  and  in 
six  cases  mouth  breathing  persisted  after  the  removal  of  adenoids. 
It  became  a  more  pronounced  habit  or  defect  wdth  age;  12.7  per  cent 
of  the  children  2  to  3  years  of  age,  and  56.2  per  cent  of  those  6  to  7 
years  of  age  were  moutli  breathers.  This  symptom  or  defect  was 
more  common  among  boys,  showing  43.1  per  cent  as  compared  with 
35.8  per  cent  among  girls. 


48  PHYSICAL   STATUS  OF   PRESCHOOL   CHH,DREX. 

Malocclusion  and  high-arch  palate  apparently  had  a  direct  relation 
to  mouth  breathing,  since  62.4  per  cent  of  the  children  with  malocclu- 
sion and  65.4  per  cent  of  those  with  high-arch  palate  were  mouth 
breathers. 

(b)  A^asal  discharge. — Nine  and  six  tenths  per  cent  of  all  children 
had  what  was  considered  a  chronic  nasal  discharge,  10.1  per  cent  of 
the  boys  and  9  per  cent  of  the  girls. 

(c)  A'asal  obstruction. — Thirtj'-eight  and  two-tenths  per  cent  of  the 
children  showed  nasal  obstruction.  Of  the  cases  of  malocclusion 
59.8  per  cent  showed  nasal  obstruction,  as  compared  with  35.5  per 
cent  of  those  without  malocclusion. 

id)  High-arch  palaie. — According  to  the  observations  of  the 
examiners,  practically  one-third  of  all  the  children,  1,027  out  of 
3,125,  sho\ved  high-arch  palate.  This  condition  prevailed  in  more 
than  half  (57.4  per  cent)  of  the  cases  of  malocclusion,  and  in  a  still 
higher  percentage  (59.5)  of  the  positive  cases  of  adenoids. 

(e)  Ear  drums. — Retracted  drums,  which  were  considered  a  cor- 
roborative sign  of  adenoids,  were  found  in  258  of  the  cases  examined 
by  the  specialist.  This  is  probably  an  understatement,  since  not 
all  children  were  observed  by  the  specialist.  In  94.6  per  cent  of  the 
cliildren  with  retracted  drums,  adenoids  were  also  found. 

Hearing  appears  to  have  been  only  slightly  impaired  by  retracted 
di'ums  either  with  or  without  adenoids,  since  it  was  found  to  be 
defective  in  only  8,  or  3.5  per  cent,  of  the  231  cases  of  retracted  ear 
drums  in  which  hearmg  was  tested,  as  compared  with  1  per  cent  in 
the  rest  of  the  group. 

(/)  Adenoid facits. — So-called  typical  adenoid  facies  were  observed 
in  slightly  more  than  one- third  (37.2  per  cent)  of  the  children  having 
adenoids.  This  symptom  was  more  common  in  boys  and  showed  an 
increase  with  age  to  the  seventh  year. 

Tonsils. 

A  little  less  than  half  (45.4  per  cent)  of  the  total  number  of  children 
examined  had  tonsils  which  would  generally  be  considered  normal, 
since  they  showed  no  enlargement  or  evidence  of  disease.  More  than 
half  (56.3  per  cent)  the  children  vdth.  abnormal  tonsils  also  had 
adenoids.  Of  the  entire  group  2.5  per  cent,  or  1  in  40,  gave  a  history 
of  having  had  tonsils  removed. 

Slight  enlargement  of  the  tonsils  was  far  more  common  than  other 
tonsillar  affections,  being  found  in  slightlj^  more  than  one-third 
(34.9  per  cent)  of  the  children.  The  maximum  of  simple  enlargement, 
which  increased  in  prevalence  with  each  year  of  age,  was  reached 
during  the  fifth  year,  and  thereafter  a  steady  and  even  decrease  was 
shown.  Possibly  these  findings  suggest  that  enlargement  without 
disease  may  be  merely  a  hyperplasia  of  lymphoid  tissue,  normal  at 
this  period  of  life. 


PHYSICAL.  FINDINGS. 


49 


Table  XVI. — Condition  of  tonsils,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination. 


Condition  of  tonsils,  and  sex. 


Total 
children. 


Num- 
ber. 


Both  sexes 3, 125 


Tonsils: 

Normal 

Defective 

Enlarged  only 

Greatly  enlarged  only 

Diseased 

Enlarged 

Greatly  enlarged . 

Not  enlarged 

Removed 


Boys. 


Tonsils: 

Normal 

Defective 

Enlarged  only 

Greatly  enlaiged  only. 
Diseased 

Enlarged 

Greatly  enlarged . . 

Not  enlarged 

Removed 


1,420 

1,626 

1,091 

129 

406 

266 

134 

6 

79 

1,555 


Girls. 


Tonsils: 

Normal 

Defective 

Enlarged  only 

Greatly  enlarged  only. 

Diseased .". 

Enlarged 

Greatly  enlarged. 

Not  enlarged 

Removed 


671 
836 
574 

61 
201 
132 

65 
4 

48 


749 
790 
517 

68 
205 
134 

69 
2 

31 


Per  cent 
distri- 
bution. 


2  years,  under  3. 


Num- 


45.4 
52.0 
34.9 

4.1 
13.0 

8.5 

4.3 
.2 

2.5 


100.0  I      261 


308 
203 
188 
5 
10 
5 
5 


43.2 
53.8 
36.9 

3.9 
12.9 

8.5 

4.2 
.3 

3.1 

100.0 


151 
110 
101 
3 
6 
3 
3 


250 


Per  cent 
distri- 
bution. 


100.0 


60.3 
39.7 
36.8 
1.0 
2.0 
1.0 
1.0 


57.9 
42.1 
38.7 
1.1 
2.3 
1.1 
1.1 


100.0 


3  years,  under  4, 


Num- 
ber. 


237 

254 
211 
10 
33 
21 
12 


5 
251 


115 

132 

110 

5 

17 

10 

7 


4 
245 


Per  cent 
distri- 
bution. 


4  years,  under  5. 


Num- 
ber. 


549 


47.8 
51.2 
42.5 
2.0 
6.7 
4.2 
2.4 


1.0 
100.0 


223 

319 

244 

20 

55 

31 

23 

1 

7 


45.8 
52.6 
43.8 
2.0 
6.8 
4.0 
2.8 


1.6 
100.0 


108 

163 

126 

8 

29 

16 

12 

1 

3 

275 


47.7 
50.3 
32.9 

4.3 
13.1 

8.5 

4.4 
.1 

2.0 


157 
93 
87 
2 
4 
2 
2 


62.8 
37.2 
34.8 


122 
122 
101 
5 
16 
11 
5 


49.8 
49.8 
41.2 
2.0 
6.5 
4.5 
2.0 


115 
156 
118 
12 
26 
15 
11 


Per  cent 
distri- 
bution. 


40.6 
58. 1 
44.4 

3.6 
10.0 

5.6 

4.2 
.2 

1.3 

100.0 


39.4 
59.5 
46.0 

2.9 
10.6 

5.8 

4.4 
.4 

1.1 

100.0 


41.8 
56.7 
42.9 
4.4 
9.5 
5.5 
4.0 


1.5 


Condition  of  tonsils,  and  sex. 


Both  sexes. 


Tonsils: 

Normal 

Defective 

Enlarged  only 

Greatly  enlarged  only . 
Diseased 

Enlarged 

Greatly  enlarged . . 

Not  enlarged 

Removed 


Boys.... 

Tonsils: 

Normal . 
Defective . 


5  years,  under  6. 


Num- 
ber. 


Per  cent 
distri- 
bution, 


667 


263 
377 
221 

42 
114 

78 

34 
2 

27 


100.0 


39.4 
56.5 
33.1 

6.3 
17.1 
11.7 

5.1 
.3 

4.0 

100.0 


123 

i  198 

Enlarged  only 112 

" !  27 

59 

41 

16 

2 

16 


Greatly  enlarged  only . 
Diseased 

Enlarged 

Greatly  enlarged. . 

Not  enlarged 

Removed 


36.5 
58.  8 
33.2 

8.0 
17.5 
12.2 

4.7 
.6 

4.7 


6  years,  under  7. 


Num- 
ber. 


285 
365 
176 

39 
150 

99 

49 
2 

32 


132 
183 

98 
15 
70 
49 
21 


Per  cent 
distri- 
bution. 


100.0 


41.8 
53.5 
25.8 

5.7 
22.0 
14.5 

7.2 
.3 

4.7 

100.0 


39.5 
54.8 
29.3 

4.5 
21.0 
14.7 

6.3 


5.7 


7  years,  under  8. 


Num- 
ber. 


104 
108 
51 
13 
44 
32 
11 
1 


Per  cent 
distri- 
bution. 


47.3 
49.1 
23.2 

5.9 
20.0 
14.5 

5.0 
.5 

3.6 

100.0 


42.9 
51.0 
27.6 
3.1 
20.4 
13.3 
6.1 
1.0 
6.1 


108178' 


50 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREjST. 


Table  XVI. — Condition  of  tonsils,  by  age  and  sex;  children  2  to  7  years  oj  age  given 
physical  examination — Concluded. 


Condition  of  tonsils,  and  sex. 


5  years,  under  6. 


Num- 
ber. 


Per  cent 
distri- 
bution. 


6  years,  under?. 


Num- 
ber. 


Percent 
distri- 
bution. 


7  years,  under  8. 


Num- 
ber. 


Percent 
distri- 
bution. 


Girls. 


Tonsils: 

Normal 

Defective 

Enlarged  only 

Greatly  enlarged  only . 

Diseased 

Enlarged 

Greatly  enlarged . . 

Not  enlarged 

Removed 


330 


100.0 


100.0 


140 
179 
109 
15 
55 
37 
18 


42.4 
54.2 
33.0 

4.5 
16.7 
11.2 

5.5 


3.3 


153 
182 
78 
24 
80 
50 
28 
2 
13 


44.0 
52.3 
22.4 

6.9' 
23.0 
14.4 

S.O 
.6 

3.7 


50.8 
47.5 
19.7 

8.2 
19.7 
15.6 

4.1 


1.6 


Greatly  enlarged  tonsils,  i.  e.,  those  nearly  filling  the  throat,  were 
found  in  only  8.4  per  cent  of  the  children;  in  one-half  these  cases  the 
tonsils  were  also  diseased.  This  degree  of  enlargement  also  showed 
definite  increase  with  age. 

TonsUs  considered  ''diseased"  were  found  in  13  per  cent  of  all  the 
children  in  the  group  and  showed  a  steady  increase  from  2  per  cent 
in  the  2-  to  3-year  group  to  22  per  cent  in  the  6-  to  7-year  group. 

Practically  all  "diseased''  tonsils  showed  some  enlargement;  in 
only  six  cases  were  the  tonsils  recorded  as  "diseased"  but  not  "en- 
larged." Approximately  two-thirds  of  the  "diseased"  tonsils  were 
associated  ^dtli  slight  enlargement,  the  other  third  being  recorded  as 
"greatly  enlarged." 

The  standards  adopted  in  this  study  for  the  recommendation  of 
the  removal  of  tonsils  ^'^  compelled  a  rather  conservative  viewpoint, 
but  in  spite  of  this  it  was  considered  ])y  the  specialist  that  removal 
was  required  in  39.3  per  cent  of  the  1,626  cases  of  tonsillar  defect. 
Parents  were  instructed  to  keep  the  throats  of  the  remaining  number 
under  observation. 

Removal  was  recommended  more  commonly  among  the  older  chil- 
dren, the  percentages  based  upon  total  number  of  children  having  de- 
fective tonsils  ranging  from  6.9  at  2  to  3  years,  to  61.9  at  6  to  7  years. 

Removal  of  both  tonsils  and  adenoids  was  recommended  in  57.3 
per  cent  of  the  cases  in  which  both  conditions  were  present.  Re- 
moval of  tonsils  alone  was  necessary  in  but  7.1  per  cent  of  all  cases 
of  defective  tonsils. 

Table  XVII  indicates  a  definite  relation  between  diseased  tonsils 
and  age,  but  apparently  shows  little  relation  between  decayed  teeth 
and  diseased  tonsils. 


"  See  p.  25, 


PHYSICAL  FINDINGS. 


51 


Table  XVII. — Prevalence  of  diseased  tonsils,  by  presence  of  decayed  teeth;  children  2  to 
7  years  of  age  given  physical  examination. 


Age. 


Children  without  decayed 
teeth. 


Total. 


With  diseased 

tonsils. 


Number.  Per  cent 


Children  with  decayed  teeth. 


Total. 


With  diseased 
tonsils. 


Number.  Per  cent.i 


2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 


403 
278 
185 
134 
84 
20 


2.0 
5.8 
8.1 
19.4 
21.4 


108 
218 
364 
533 
598 
200 


2 

17 
40 
88 
132 

42 


1.9 

7.8 

11.0 

16.5 

22.1 


1  Not  shown  where  base  is  less  than  50. 

There  appeared  to  be  no  striking  difference  in  the  condition  of  the 
tonsils  of  the  children  of  native  and  foreign-born  white  parentage; 
defective  tonsils  were  found  in  51.5  per  cent  of  the  latter  as  against 
53.2  per  cent  of  the  former.  The  highest  per  cent  found  in  any  na- 
tionality group  was  57.9  in  the  Serbo-Croatians,  while  the  lowest  per 
cent  (47.9)  was  found  among  the  colored  children. 

Correlations  with  earnings  did  not  even  suggest  that  the  children 
of  well-to-do  parents  had  fewer  tonsillar  defects  than  those  of  poorer 
families,  except  that  a  larger  per  cent  in  the  higher  income  groups 
had  had  tonsils  removed. 

GLANDS. 

The  condition  of  the  superficial  external  lymphatic  glands  as  to 
size  and  associated  infection  is  shown  in  Table  XVIII. 

Since  a  certain  degree  of  swelling  and  hyperplasia  is  considered 
normal  during  early  childhood,  only  glands  described  as  "enlarged" 
or  "greatly  enlarged"  were  in  this  study  considered  as  defects. 
However,  in  17.6  per  cent  of  the  children  glands  were  not  even 
"palpable,"  and  for  this  reason  further  observation  seems  necessary 
to  determine  w^hether  or  not  palpability  should  be  considered  normal 
even  at  this  period  of  life. 


52 


PHYSICAL  STATUS  OF   PRESCHOOL   CHBLDREIT, 


Table  XVIII. — Condition  of  glands,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination. 


Total  children. 

2  years 

under  3. 

3  years 

under  4. 

4  years 

under  5. 

Condition  of  glands,  and  sex. 

Num- 
ber. 

Percent 
distri- 
bution. 

Num- 
ber. 

Per  cent 
distri- 
bution. 

Nimi- 
ber. 

Per  cent 
distri- 
bution. 

Num- 
ber. 

Per  cent 
distri- 
bution. 

Both  sexes 

3,125 

100.0 

511 

100.0 

496 

100.0 

549 

100.0 

Glands: 

Nonpalpable 

Palpable 

Enlarged  or  greatly  enlarged 

Without  associated  infection . 
With  associated  infection 

Boys 

550 
1,667 
908 
143 
765 

1,555 

17.6 
53.3 
29.1 
4.6 
24.5 

100.0 

195 
250 
66 
26 
40 

261 

38.2 

48.9 

12.9 

5.1 

7.8 

100.0 

131 

289 

76 

17 

59 

251 

26.4 
58.3 
15.3 
3.4 
11.9 

100.0 

87 
312 
150 

20 
1.30 

274 

15.8 

56.8 
27.3 
3.6 
23.7 

100.0 

Glands: 

260 
806 
489 
74 
415 

1,570 

16.7 
51.8 
31.4 
4.8 
26.7 

100.0 

99 
131 
31 
12 
19 

250 

37.9 

50.2 

11.9 

4.6 

7.3 

100.0 

68 
128 
45 
11 
34 

245 

27.1 
55.0 
17.9 
4.4 
13.5 

100.0 

32 
160 
82 
11 
71 

275 

11.7 

Palpable 

Enlarged  or  greatly  enlarged > 

Without  associated  infection. 
With  associated  infection 

Girls  

58.4 
29.9 
4.0 
25.9 

100.0 

Glands: 

Nonpalpable 

Palpable 

Enlarged  or  greatly  enlarged 

Without  associated  infection. 
With  associated  infection 

290 
861 
419 
69 
350 

18.5 
54.8 
26.7 
4.4 
22.3 

96 
119 
35 
14 
21 

38.4 

47.6 

14.0 

5.6 

8.4 

63 

151 

31 

6 

25 

25.7 
61.6 
12.7 
2.4 
10.2 

55 
152 
68 
9 
59 

20.0 
55.3 
24.7 
3.3 
21.5 

sex. 

5  years 

under  6. 

6  years 

under  7. 

7  years 

under  8. 

Condition  of  glands,  and 

Num- 
ber. 

Per  cent 
distri- 
bution. 

Num- 
ber. 

Per  cent 
distri- 
bution. 

Num- 
ber. 

Per  cent 

distri- 
bution. 

Both  sexes 

667 

100.0 

682 

100.0 

220 

100.0 

Glands: 

Nonpalpable 

71 

346 
250 
34 
216 

337 

10.6 
51.9 
37.5 
5.1 
32.4 

100.0 

47 
370 
265 

28 
237 

334 

6.9 

54.3 

38.9 

4.1 

34.8 

100.0 

19 
100 
101 
18 
83 

98 

8.6 

45.5 

Enlarged  or  greatly  enlarged 

Without  associated  infection. 
With  associated  infection 

45.9 

8.2 

37.7 

Boys 

100.0 

Glands: 

Nonpalpable 

Palpable 

Enlarged  or  greatly  enlarged 

Without  associated  infection. 

36 
165 
136 

17 
119 

330 

10.7 
49.0 
40.4 
5.0 
35.3 

100.0 

18 
168 
148 

13 
135 

348 

5.4 
50.3 
44.3 

3.9 
40.4 

100.0 

7 
44 
47 
10 
37 

122 

7.1 
44.9 
48.0 
10.2 

With  associated  infection 

37.8 

Girls 

100.0 

Glands: 

Nonpalpable 

Palpable 

35 
181 
114 
17 
97 

10.6 
54.8 
34.5 
5.2 
29.4 

29 
202 
117 

15 
102 

8.3 
58.0 
33.6 

4.3 
29.3 

12 
56 
54 
8 
46 

9.8 
45.9 

Enlarged  or  greatly  enlarged 

Without  associated  infection. 
With  associated  infection 

44.3 
6.6 
37.7 

PHYSICAL  FINDINGS. 


53 


Table  XIX. — Condition  of  cervical  glands,  by  condition  of  tonsils  and  teeth;  children  2 
to  7  iiears  of  age  given  physical  examination. 


Total 
chil- 
dren. 

Condition  of  cervical  glands. 

Condition  of  tonsils  and  teeth. 

Nonpalpa- 

Palpable. 

Enlarged. 

Greatly  en- 
larged. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

Num-     Per 
ber.   !  cent. 

i 

Num- 
ber. 

Per 

cent. 

Total 

3,125 

898 

28.7 

1,986 

03.6 

233         7.5 

8 

0  3 

With  decayed  teeth  or  diseased  ton- 
sils  

Decayed  teetli 

Diseased  tonsils 

2,106 

1,700 

85 

321 

1,019 

476 
407 
24 
45 

422 

22.6 
23.9 

28.  2 
14.0 

41.4 

1,438 

1,155 

56 

227 

548 

68. 3 
67.9 
65.9 
70.7 

53.8 

186 

133 

5 

48 

47 

8.8 
7.8 
5.9 
15.0 

4.6 

6 
5 

.3 
.3 

Both 

Without  decayed  teeth  or  diseased 
tonsils 

1 
2 

.3 

.2 

The  highest  per  cent  of  '•  palpable  "  glands  (58.3)  was  found  among 
children  in  their  fourth  year.  This  was  a  considerable  increase  over 
the  48.9  per  cent  found  among  children  in  their  third  year.  Only  a 
slight  diminution  in  palpability  was  noticeable  in  the  succeeding 
age  groups. 

Definite  "enlargement,"  sufficient  to  be  considered  pathological, 
was  observed  in  29.1  per  cent  of  the  cases;  and  all  but  about  15.7  per 
cent  of  this  number  showed  an  associated  infection  causing  the  en- 
largement. 

"Enlarged"  glands,  with  or  without  associated  infection — while 
present  in  nearly  13  per  cent  at  2  to  3  years  of  age — show^ed  num- 
bers steadily  increasing  with  age,  and  no  tendency  to  diminution 
even  during  the  seventh  year.  As  vdth  most  other  defects,  there 
was  a  slightly  higher  per  cent  in  boys. 

The  submaxillary  and  cervical  glands  were  by  far  the  most  com- 
monly "enlarged,"  and  showed  associated  infection  more  frequently 
than  any  other  group.  While  not  so  many  children  had  "palpable" 
submaxillary  glands  (43  per  cent)  as  had  "palpable"  cervical  glands 
(63.6  per  cent),  a  larger  number — nearly  tliree  times  as  many — had 
"enlarged"  submaxillary  glands  (20.9  per  cent)  than  had  "enlarged" 
cervical  glands  (7.5  per  cent) .  A  very  definite  form  of  infection,  such 
as  decayed  teeth  or  diseased  tonsils,  was  associated  with  84.3  per  cent 
of  the  cases  of  "enlarged"  glands. 

In  14  per  cent  of  the  children  with  both  decayed  teeth  and  diseased 
tonsils,  the  cervical  glands  w^ere  not  even  "palpable;"  and  21.2  per 
cent  of  the  children  with  these  defects  had  "nonpalpable"  submaxil- 
lary glands. 

Inguinal  glands  were  "palpable"  in  1,028  children,  or  32.9  per  cent 
of  all  those  included  in  the  study,  and  "enlarged"  in  49  children — 36 
boys  and  13  girls.  No  associated  infection  was  reported  with  any 
condition  of  this  group  of  glands. 


54 


PHYSICAL   STATUS    OF    PRESCHOOL    CHILDPvEX, 


Twenty-one  boys  and  39  girls  were  found  to  have  thyroid  enlarge- 
ment, a  condition  unusual  for  children  of  these  ages,  although  fairly 
common  at  later  ages  in  the  Great  Lakes  region. 

Apparentl}^  little  significance  can  be  attached  to  the  findings  in 
regard  to  the  other  gland  groups.  Occipital  glands  were  ''palpable'' 
in  only  21  cases  (0.7  per  cent)  and  ''enlarged"  in  only  2.  The 
axillary  group  of  glands  were  "palpable"  in  3.2  per  cent  of  the  cases, 
and  enlarged  in  only  0.4  per  cent.  "Palpable"  epitrochlear  glands 
were  reported  in  2  boys. 

Correlations  to  determine  any  existing  relations  between  the 
condition  of  the  glands  and  other  physical  factors  were  made.  There 
appeared  to  be  no  connection  between  glandular  enlargement  and 
underweight;  in  fact,  a  higher  percentage  (20.1)  of  those  10  per  cent 
or  more  undei-weight  had  normal  glands  than  of  those  of  average  or 
above  average  weight  (17.6).  Similarly,  a  higher  percentage  (29.1) 
of  "enlarged"  glands  was  found  in  children  of  average  weight,  or 
above,  than  in  those  10  per  cent  or  more  below  average  (27.4  per  cent). 

Of  243  pale  or  anemic  children,  133  (54.7  per  cent)  had  "palpable" 
glands  and  98  (40.3  per  cent)  had  "enlarged"  glands. 

Glandular  defects  showed  more  striking  difference  according  to 
nationality  than  did  other  defects,  being  found  in  32.5  per  cent  of  the 
children  of  foreign-born  parentage  and  in  only  23.5  per  cent  of  those 
of  native  parentage.  The  highest  percentage  having  glandular 
defects  (47)  was  found  among  the  Lithuanians. 

Table  XX. — Condition  of  glands,  by  color  and  nationality  of  mother;  children  2  to  7 
years  of  age  given  physical  examination. 


Total 
chil- 
dren. 

Condition  of  glands. 

Non- 
palpable. 

Palpable. 

Enlarged  or  greatly  enlarged. 

Color  and  nationality  of  mother. 

Total. 

With 
associated 
infection. 

Without 
associated 
infection. 

Num- 
ber. 

Per 
cent.i 

Num- 
ber. 

Per 
cent.' 

Num- 
ber. 

Per 

cent.i 

Num- 
ber. 

Per 
cent.i 

Num- 
ber. 

Per 
cent.i 

Total 

3,125 

3,047 

1,151 

1,896 

321 

313 

224 

176 

157 

139 

83 

483 

71 

7 

550 

544 

254 

290 

39 

52 

37 

18 

16 

17.6 
17.9 
22.1 
15.3 
12.1 
16.6 
16.5 
10.2 
10.2 

1,667 

1,617 

627 

990 

168 

160 

113 

102 

94 

74 

37 

242 

46 

4 

53.3 
53.1 
54.5 
52.2 
52.3 
51.1 
50.4 
58.0 
59.9 
53.2 
44.6 
50.1 
64.8 

908 

8S6 

270 

616 

114 

101 

74 

66 

47 

39 

39 

146 

20 

2 

29.1 
29.1 
23.5 
32.5 
35.5 
32.3 
33.0 
31.8 
29.9 
28.1 
47.0 
30.2 
28.2 

765 
752 
236 
516 
96 
92 
60 
44 
32 
34 
32 
126 
12 

24.5 
24.7 
20.5 
27.2 
29.9 
29.4 
26.8 
25.0 
20.4 
24.5 
38.6 
26.1 
16.9 

143 

134 

34 

100 

18 

9 

14 

12 

15 

5 

7 

20 

8 

1 

4.6 

^^^lite 

Native 

4.4 
3.0 
5.3 

Serbo-Croatian 

Slovak 

.5.6 
2.9 

Polish.     .            

6.3 

Magyar 

Italian .  .. 

6.8 
9.6 

26     18. 7 

7       8.4 

95     19. 7 

5       7.0 

3.6 

Lithuanian.        

8.4 

All  other 

4.1 

Negro 

11.3 

Not  reported. . . . 

1  ....;. 

1  Not  .shown  where  base  is  less  than  50. 


PHYSICAL  FINDINGS.  55 

Colored  children  showed  a  higher  per  cent  of  "palpable"  glands 
than  any  other  racial  group;  a  per  cent  of  "defective"  glands  midway 
between  those  of  the  children  of  foreign-born  white  parentage  and  of 
native  white  parentage;  and  a  decided  lack  of  "associated  infection" 
with  all  degrees  of  enlargement. 

LUNGS. 

A  comparatively  small  number  of  children  showed  symptoms  of 

respiratory  disease.     Positive  diagnoses  on  one  examination  were 

possible  in  only  11  cases  (0.4  per  cent),  the  majority  of  these  being 

bronchitis.     An  additional  21  cases  (0.7  per  cent)  were  considered 

suspicious,   and  were  referred  for  medical  supervision."     A  slightly 

higher  percentage   (18.8)   of  diseased  tonsils  was  found  in  children 

with  lung  disease  (definite  and  suspected)  than  in  those  without  such 

disease  (12.9  per  cent). 

HEART. 

A  positive  diagnosis  of  organic  heart  disease  was  possible  in  only  14 
cases,  or  0.4  per  cent  of  all.  A  group  of  85  cases  (2.7  per  cent)  were 
reported  as  "suspected  heart  disease"  and  requiring  observation, 
since  it  was  impossible  to  make  a  definite  diagnosis  on  only  one 
examination.  Functional  murmurs  without  other  heart  s3^mptoms 
were  reported  in  68  cases  (2.2  per  cent).  Onl}^  2  cases  of  functional 
murmur  were  reported  as  early  as  the  third  year,  but  the  number 
steadily  increased  with  age,  reaching  25  during  the  seventh  year. 

SKIN. 

Under  this  subject  were  included  not  only  definite  skin  diseases  but 
pediculosis  as  well.  This  latter  condition  far  exceeded  all  other  skin 
affections,  being  found  in  4.6  per  cent  of  all  the  children.  Pediculosis 
was  three  times  as  frequent  among  girls  as  among  boys,  and  its  preva- 
lence increased  steadily  with  age,  so  that  by  far  the  larger  number 
of  cases  was  found  among  children  over  5  years  of  age.  The  number 
of  cases  of  pediculosis  of  the  body  was  practically  negligible. 

Of  the  skin  diseases,  eczema  was  most  common,  occurring  in  80 
cases  (2.6  per  cent).  There  were  also  67  cases  of  infected  sores;  29  of 
ringworm,  chiefly  of  scalp  and  face;  9  cases  of  scabies;  and  8  cases  of 
impetigo.  With  the  exception  of  infected  sores  and  ringworm  these 
diseases  were  more  commonly  found  in  the  later  ages,  i.  e.,  those  over 
5  years. 

-  Under  "other  conditions  "  were  listed  scars,  with  their  causes  when 
these  could  be  ascertained.  A  surprisingly  large  number,  165,  or 
5.3  per  cent,  were  found  to  have  scars  of  one  kind  or  another.  "Un- 
reported causes  "  was  recorded  for  the  majority,  but  the  most  common- 
ly reported  causes  were  bums  (26.7  per  cent)  and  operations  (15.2 
per  cent).  Doubtless  many  of  the  scars,  the  causes  of  which  were 
unreported,  were  in  fact  the  result  of  burns  or  other  accidents. 


56 


PHYSICAL  STATUS   OF   PRESCHOOL   CHILDREN. 


Abnormal  skin  conditions  were  more  common  in  the  older  children, 
14.1  per  cent  in  the  seventh  year  or  later  as  compared  with  4.9  per 
cent  during  the  third  year. 

No  marked  relation  was  shown  between  underweight  and  abnormal 
skin  condition,  but  malnutrition,  plus  skin  defects,  was  found  to  be 
accompanied  by  a  high  per  cent  of  anemia.  The  increase  in  skin 
defects  was  from  zero  among  the  ''excellent"  to  21.6  per  cent  among 
the  ''good, "  27.3  per  cent  among  the  "poor, "  and  60  per  cent  among 
the  "very  poor." 

Children  of  foreign-bom  mothers  were  more  commonly  subject  to 
abnormal  skin  conditions  than  those  of  native  parents,  the  percent- 
ages being  13.2  and  4.9,  respectively.  The  groups  in  which  the  per- 
centage of  this  defect  most  nearly  approached  that  of  the  native 
white  group  were  the  German,  with  5.8  per  cent;  and  the  Polish,  with 
7.1  per  cent;  a  maximum  of  22.9  per  cent  was  reached  among  the 
Italian  and  the  Lithuanian. 

Correlations  with  incomes  show  definitely  that  the  children  of  the 
more  prosperous  families  were  freer  from  abnormal  skin  conditions 
than  those  in  the  lower-income  groups ;  the  percentage  of  children  in 
whom  such  conditions  were  found  decreased  from  16.4  among  families 
where  the  father  earned  less  than  S850  to  only  5.6  in  the  group  where 
the  fathers  earned  S2,250  or  more.  Low  standards  of  living,  including 
lack  of  bathing  facilities,  ignorance  as  to  proper  care  and  habits  of  the 
body  and  proper  food,  etc.,  prevailed  to  a  greater  degree  among  the 
families  of  the  low-income  groups. 

ABDOMEN. 

Abdominal  distension  was  most  frequently  observed  in  the  younger 
children,  being  present  in  19.8  per  cent  of  those  in  their  third  year  of 
age.  A  gradual  decrease  in  the  prevalence  of  this  defect  was  notice- 
able in  each  succeeding  age  group.  This  condition  was  evenly  dis- 
tributed according  to  sex. 

Distended  abdomen  was  more  commonly  observed  in  children  with 
rachitic  defects  (23.1  per  cent)  than  in  nonrachitic  children  (11  per 
cent) . 

Table  XXI. — Distended  abdomen,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination. 


Age  and  sex . 


;     Total 
children. 


Both  sexes 3, 125 

2  years,  under  3 511 

3  years,  under  4 496 

4  years,  under  5 549 

5  years,  under  6 667 

6  years,  under  7 682 

7  years,  under  8 ,  220 


With  distended 
abdomen. 


Number.   Per  cent, 


423 


101 
75 
70 
77 
74 
26 


13.5 


Without 
distend- 
ed abdo- 
men. 


2,702 


19.8 

410 

15.1 

421 

12.8 

479 

11.5 

590 

10.9 

608 

11.8 

194 

PHYSICAL  FINDINGS. 


57 


Table  XXI. — Distended  abdomen,  by  age  and  sex;  children  2  to  7  years  of  age  given 
physical  examination — Concluded. 


Age  and  sex . 


Boys 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  G 

6  years,  under  7 

7  years,  under  8 

Girls 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 


Total 
children. 


261 
251 
274 
337 
334 


1,570 


250 
245 
275 
330 
348 
122 


With  distended 
abdomen. 


Number.    Per  cent 


50 
35 
40 
42 
32 
15 

209 


13.8 


19.2 
13.9 
14.6 
12.5 
9.6 
15.3 

13.3 


20.4 
16.3 
10.9 
10.6 
12.1 
9.0 


Without 
distend- 
ed abdo- 
men. 


1,341 


211 
216 
234 
295 
302 
83 

1,361 


199 
205 
245 
295 
306 
111 


Of  the  children  of  average  weight  or  above,  19.5  per  cent  had 
abdominal  defect,  while  smaller  percentages — 11.4,  10.5,  and  12.5 — 
of  the  children  in  the  underweight  groups  showed  this  defect. 

There  were  11  cases  of  enlarged  liver — 0.4  per  cent  of  all  exam- 
ined— and  none  of  enlarged  spleen. 

Hernias  were  found  in  47  cases,  36  umbilical  and  11  inguinal,  only 
1  of  the  latter  variety  being  in  a  girl.  Four  boys  had  operations  for 
this  condition. 

BONY  AND  MUSCULAR  SYSTEMS. 

A  simple  enumeration  of  bony  and  muscular  defects  is  given  in 
General  Table  7,  page  69.  One  defect  of  the  bony  and  muscular 
system  appeared  in  41.9  per  cent  of  the  children.  Distribution  of 
these  defects  by  age  showed  a  gradual  increase  from  24.9  per  cent  in 
the  third  year  to  56.2  per  cent  in  the  seventh  year. 

Table  XXII. — Defects  of  bony  and  muscular  system,  by  age  and  sex;  children  2  to  7  years 
of  age  given  physical  examination. 


Age  and  sex. 


Total 
children. 


With  defects  of 
bony  and  mus- 
cular system. 


Number. 


Per  cent. 


Without 
defects 
of  bony 

and  mus- 
cular 

system. 


Both  sexes 

2  years,  under  3 . 

3  years,  under  4. 

4  years,  under  5. 

5  years,  under  6 . 

6  years,  under  7 . 

7  years,  under  8 . 

Boys 

2  years,  under  3 . 

3  years,  under  4. 

4  years,  under  5 . 


3,125 


1,308 


511 
496 
549 
667 
682 
220 

1,555 


127 
144 
204 
324 
383 
126 

709 


261 
251 
274 


68 
76 
111 


41.9 


24.9 
29.0 
37.2 
48.6 
56.2 
57.3 

45.6 


26.1 
30.3 
40.5 


384 
352 
345 
343 
299 
94 


193 
175 
163 


58 


PHYSICAL   STATUS    OF   PRESCHOOL   CHILDREN. 


Table  XXII. — Defects  of  bony  and  muscular  system,  by  age  and  sex;  children  2  to  7 
years  of  age  given  physical  examination — Concluded. 


Age  and  sex. 


5  years,  under  fl . 

6  years,  under  7. 

7  years,  under  8 . 

Girls 


Total 
children. 


337 
334 


1,570 


2  years,  under  3 . 

3  years,  under  4 . 

4  years,  under  5. 

5  years,  under  6 . 

6  years,  under  7. 

7  years,  imder  8 . 


250 
245 
275 
330 
348 
122 


With  defects  of 
bony  and  mus- 
cular system. 


Number.    Per  cent 


183 
208 
63 


59 
68 
93 
141 
175 
63 


54.3 
62.3 
64.3 

38.2 


23.6 
27.8 
33.8 
42.7 
50.3 
51.6 


Without 
delects 
of  bony 

and  mus- 
cular 
system. 


154 
126 
35 

971 


191 
177 
182 
189 
173 
69 


On  the  whole,  the  percentage  of  boys  (45.6)  with  defects  of  the 
bony  and  muscular  systems,  exceeded  that  of  girls  (38.2). 

In  general,  the  incidence  of  these  defects  in  the  various  weight 
groups  was  not  sufficiently  uniform  to  suggest  any  definite  correlation 
with  weight.     (See  general  Table  5,  p.  68.) 

Bony  defects  of  rachitic  origin. 

Since  a  large  number  of  the  bony  defects  were  considered  to  be 
of  rachitic  origin,  tabulations  based  on  this  causative  factor  were 
made. 

Bony  defects  tabulated  as  ^'unquestionably"  the  result  of  rickets 
were:  Beaded  ribs,  Harrison's  groove,  enlarged  epiphyses,  pigeon 
breast,  craniotabes,  and  lumbar  kyphosis  if  it  was  accompanied  by 
one  of  the  group  of  '^ probable  signs"  of  rickets  such  as  large  square 
head  or  open  fontanelle  after  18  months  of  age.  Bowlegs  or  knock- 
knees  were  considered  as  merely  additional  evidence  of  rickets  and, 
unless  other  rachitic  signs  appeared  with  them,  were  disregarded. 
In  combination  with  lumbar  kyphosis  they  were  called  unquestion- 
able signs  of  rickets. 

Three  hundred  and  eighty-eight  children  (12.4  per  cent)  were  con- 
sidered as  having  defects  definitely  the  result  of  rickets,  while  an 
additional  79  children  (2.5  per  cent)  had  defects  ''probably  of  rachitic 
origin,"  bringing  the  total  of  those  having  defects  possibly  due  to 
early  rickets  to  14.9  per  cent. 

Rickets  is  usually  conceded  to  be  a  disease  of  infancy,  the  symp- 
toms of  which  disappear  early  under  proper  dietary  and  hygienic 
conditions;  hence  the  prevalence  and  persistence  of  these  excessively 
high  percentages  probably  due  to  rickets  lead  to  the  inference  that 
the  corrective  measures  of  diet,  hygiene,  and  environment  had  not 
entered  into  the  lives  of  this  preschool  group.  This  conclusion  is 
perhaps  further  substantiated  by  the  fact  that  these  defects  showed 


PHYSICAL   FINDINGS.  59 

no  tendency  to  diminish,  even  in  the  older  children,  but  increased 
steadily. 

Correlations  between  bony  defects  of  rachitic  origin  and  the  con- 
dition of  the  teeth  showed  a  higher  per  cent  (75.2)  of  decayed  teeth 
in  the  children  with  such  bony  defects  than  in  those  without  (62.8). 

Slightly  more  than  half  (54.2  per  cent)  of  the  children  with  rachitic 
bone  defects  were  found  to  have  defective  tonsils  as  compared  with 
51.7  per  cent  of  children  without  such  defects. 

Children  without  rachitic  bone  defects  had  a  much  higher  per  cent 
of  nonpalpable  lymphatic  glands  (19.4  per  cent)  than  those  with 
such  defects  (7.3  per  cent) . 

The  prevalence  of  rachitic  defects  was  greater  among  the  children 
of  foreign-born  white  pa,rentage  (17.7  per  cent)  than  among  those  of 
native  white  parentage  (10.4  per  cent).  Of  the  former,  the  Serbo- 
Croatians  had  the  highest  per  cent  (22.1  per  cent).  Contrary  to  the 
general  impression,  the  colored  children,  although  a  small  group, 
showed  only  14.1  per  cent  with  rachitic  defects,  a  per  cent  slightly 
less  than  the  average  for  the  entire  group  (14.9  per  cent). 

While  rachitic  defects  appeared  to  be  slightly  associated  with 
underweight,  their  incidence  increased  only  from  13.1  per  cent  in  the 
''above  average"  group  to  18.8  per  cent  in  the  group  most  seriously 
underweight.  (See  general  Table  5,  p.  68.)  On  the  other  hand,  only 
12.2  per  cent  of  the  children  with  rachitic  defects  as  compared  with 
9.3  per  cent  of  the  nonrachitic  showed  10  per  cent  or  more  deviation 
from  average  weight  for  height. 

Postural  defects. 

Included  in  this  group  were  the  defects  due  to  lack  of  muscular 
development,  namely,  romid  shoulders,  winged  scapulae,  scoliosis 
and  lordosis,  and,  when  not  associated  with  rickets,  bowlegs  and 
knock-loiees. 

The  total  number  of  children  with  one  or  more  postural  defects 
was  793,  or  25.4  per  cent  of  all  those  examined.  In  children  6  to  7 
years  of  age  the  number  increased  to  over  one-third  of  the  total. 
This  at  first  appears  to  be  an  excessively  high  percentage;  but  to 
what  extent  the  conditions  may  be  interpreted  as  actual  defects  is 
perhaps  debatable,  considering  that  between  the  ages  of  2  and  6  years 
muscular  development  is  poor  and  muscle  tonus  practically  lacking. 
This  characteristic  lack  of  muscular  development  probably  explains 
in  part  the  frequency  of  winged  scapulae  in  this  study.  The  percent- 
age of  children  having  this  defect  was  14.5  for  the  whole  group,  and 
was  noticeably  higher  after  the  fourth  year.  The  increase  in  scoliosis 
appeared  more  prominently  after  the  fifth  year. 

Postural  defects,  on  the  whole,  appeared  to  bear  some  relation  to 
underweight;  for  28.7  per  cent  of  the  children  10  per  cent  or  more 


60 


PHYSICAL  STATUS  OF  PRESCHOOL  CHrLDREN". 


below  average  weight  for  height  had  one  or  more  postural  defects,  as 
contrasted  with  20.4  per  cent  of  those  whose  weight  was  average  or 
above. 

Table  XXIII. — Postural  defects,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination. 


Age  and  sex. 


Both  sexes. 

2  years,  under  3. . 

3  years,  under  4.. 

4  years,  under  5.. 

5  years,  under  6.. 

6  years,  under  7. . 

7  years,  under  8. . 


Total 
children. 


511 

496 
549 
667 
6S2 
220 


Boys. 


2  years,  under  3. 

3  years,  under  4. 

4  years,  under  5. 

5  years,  under  6. 

6  years,  under  7. 

7  years,  under  8. 

Girls 


2  years,  under  3. 

3  years,  under  4. 

4  years,  under  5. 

5  years,  under  6. 

6  years,  under  7 . 

7  years,  under  8 . 


261 
251 
274 
337 
334 


250 
215 
275 
330 
348 
122 


With  postural  de- 
fects. 


Number.   Per  cent 


56 

68 
117 
220 
255 

77 

418 


30 
40 
56 
125 
131 
36 

375 


25.4 


11.0 
13.7 
21.3 
33.0 
37.4 
35.0 

26.9 


11.5 
15.9 
20.4 
37.1 
39.2 
36.7 

23.9 


26 
2S 
61 
95 
124 
41 


10.4 
11.4 
22.2 
28.8 
35.6 
33.6 


Without 

postural 
defects. 


2,332 


455 
428 
432 
447 
427 
143 

1,137 


231 
211 
218 
212 
203 
62 

1,195 


224 
217 
214 
235 
224 
Si 


Among  the  colored  the  percentage  of  postural  defects  was  very 
high — 52.1;  among  the  children  of  native  white  parentage  it  was 
21.8,  and  among  those  of  foreign-born  white  parentage  it  was  26.6. 

The  influence  of  environment  and  living  standards  upon  develop- 
ment as  reflected  in  faulty  posture  is  sihown  by  the  incidence  of  the 
highest  per  cent  of  postural  defects  in  the  lower  wage  group;  this 
per  cent  was  27.6  in  families  whose  incomes  were  less  than  SI, 450, 
as  contrasted  with  22.1  per  cent  in  families  whose  incomes  were 
$1,450  or  over.     (See  General  table  4,  p.  67.) 

Arch  measurements. 

Since  there  appeared  to  be  no  standard  for  grading  flat  foot,  and 
since  anatomical  data  regarding  arches  in  children's  feet  were  notably 
lacking,  the  suggestion  of  a  prominent  orthopedist  that  the  study 
include  a  measurement  of  the  height  of  the  arches  in  children  was 
carried  out.  (See  instructions,  p.  20.)  The  results  are  herewith 
given  without  any  attempt  at  interpretation,  since  obviously  other 
and  more  detailed  investigations  on  the  subject  must  follow  before 
the  material  in  this  report  can  be  evaluated. 


PHYSICAL   FINDINGS. 


61 


Measurements  were  made  on  3,064  children,  and  in  only  65  cases 
were  the  arch  heights  found  to  be  unequal  in  the  two  feet.  In  com- 
puting median  arch  measurements  these  65  cases  were  discarded. 

The  accompanying  table  gives  median  arch  measurements  ac- 
cording to  sex  and  age: 

Median  arch  measurements. 


Age. 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  S 


Both 

sexes. 


Inches. 


Boys. 


Inches.  .,   Inches 


Girls. 


The  increase  in  arch  height  with  age  probably  parallels  the  mus- 
cular development  in  the  feet,  which  apparently  increases  with  use. 
Careful  observations  were  made  and  recorded  as  to  the  relation  of 
the  axes  of  the  foot  and  leg  while  the  child  was  walking.  Of  all  the 
children  81.3  per  cent  had  what  is  commonly  known  as  the  " straight" 
type  of  foot,  i.  e.,  they  toed  straight  ahead,  the  axes  of  the  foot  and 
leg  making  a  right  angle;  10.3  per  cent  were  of  the  '4nflared"  type 
with  the  foot  deflected  in;  while  6.9  per  cent  were  the  "outflared" 
type  with  the  foot  deflected  out. 

Correlations  between  the  position  of  the  foot  and  the  median 
height  of  the  arch  indicate  that  the  deflections  in  and  out  increased 
with  the  height  of  the  arch,  as  the  accompanying  figures  show: 

Median  arch  measurements. 


Age. 


Inflare. 


Outflare. 


Straight 
foot. 


2  years,  under  3 

3  years,  under  4, 

4  years,  under  5. 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 


Inches. 


Inches. 


Inches. 


NERVOUS   SYSTEM. 

The  prevalence  of  defects  of  the  nervous  system  is  shown  in  General 
Table  1.^^  Of  the  entire  group,  nervous  defects  were  noted  in  75 
children — only  2.4  per  cent.  Individual  defects  were  too  few  to  be 
of  definite  value  statistically,  and  the  clinical  findings  are  equally 
valueless  without  a  more  detailed  and  thorough  examination  than 
was  possible  in  this  study. 


isSeep.65. 


62  PHYSICAL  STATUS  OF  PRESCHOOL  CHILDREN. 

Functional  speech  defects  were  noted  in  1.7  per  cent  of  the  children, 
practically  equally  distributed  according  to  sex.  They  were  chiefly 
stammering,  stuttering,  and  lisping,  with  a  few  cases  of  poor  articu- 
lation. 

MENTAL   CONDITION. 

No  mental  tests  were  conducted  in  connection  with  this  study. 
If  the  observations  of  the  examining  physicians  or  nurses  led  to  even 
a  suspicion  of  abnormality,  the  observations  were  supplemented  by 
information  gained  from  the  teacher,  the  mother,  or  the  school 
physician  who  conducted  mental  tests.  Nineteen  apparent  mental 
defectives  and  18  suspected  cases  came  under  the  observation  of  the 
physicians  during  the  course  of  the  study. 

GENITALIA. 

An  astonishingly  high  per  cent  of  genital  defects  was  found  in 
boys,  due  almost  entirely  to  adherent  or  contracted  prepuce,  there 
bemg  437  cases  (28.1  per  cent)  of  the  former  and  289  (18.6  per  cent) 
of  the  latter.  There  were  recorded  only  22  cases  (1.4  per  cent)  of 
other  abnormalities  of  the  genitalia  than  of  the  prepuce. 


The  data  from  this  study  are  submitted  merely  as  the  results  of 
careful  routine  physical  examinations  based  upon  somewhat  stand- 
ardized methods. 

No  attempt  has  been  made  to  draw  conclusions,  since  the  findings 
point  very  definitely  to  the  need  for  further  consecutive  study  of  the 
child  before  correlations  between  existing  physical  defects  and  their 
possible  causes  may  be  determined.  Studies  of  racial,  economic, 
and  envu'onmental  factors,  breast  feeding,  growth,  intercurrent  dis- 
eases, diet,  sleep,  and  recreation,  correlated  with  the  objective 
findings  of  periodic  physical  examinations  covering  the  period  from 
birth  to  school  age,  would  undoubtedly  add  a  great  deal  to  the  present 
knowledge  of  the  physical  development  of  the  child  and  the  factors 
which  modify  it.  Such  studies  would  also  in  time  afford  a  means 
of  evaluating  present  efforts  in  the  field  of  child  hygiene. 


APPENDIXES. 


63 


APPENDIX  A. 


GENERAL  TABLES  ON  PHYSICAL  FINDINGS  OF 
THE  PRESCHOOL  CHILD. 


Table  1.- 


-Prc  valence  of  defects,  by  sex;  children 
examination. 


to  7  years  of  age  given  physical 


Summary  of  defects. 


Total 

Without  defects 

With  defects 

Underweight  (10  per  cent  and  over) . . 

Anemia 

Head  defects 

Eye  defects 

Defective  vision 

Other  defect 

Ear  defects 

Defective  hearing 

Other  defect 

Mouth  defects 

Nasopharyngeal  defects 

Enlarged  glands 

Heart  defects 

Lung  defects 

Abnormal  skin  condition 

Abdominal  defects 

Defects  of  bony  and  muscular  system 

Bony  defects  of  rachitic  origin 

Postural  defects 

Defects  of  nervous  system 

Defects  of  mentality 

Defects  of  genitalia 


Both  sexes. 


Num- 
ber. 


3,125 


149 

2,976 

303 

243 

163 

1890 

738 

2-15 

•48 

25 

25 

2,091 

2, 157 

908 

99 

32 

318 

464 

1,308 

467 

793 

75 

37 

769 


Per  cent 
distri- 
bution. 


100.0 


4.8 

95.2 

9.7 

7.8 

5.2 

28.5 

2  36.1 

7.8 

1.5 

<1.4 

.8 

66.9 

69.0 

29.1 

3.2 

1.0 

10.2 

14.8 

41.9 

14.9 

25.4 

2.4 

1.2 

24.6 


Boys. 


Num- 
ber. 


1,555 


48 

1,507 

140 

113 

105 

437 

355 

127 

30 

14 

17 

1,043 

1,118 

489 

48 

21 

137 

234 

709 

304 

418 

42 

26 

732 


Per  cent 
distri- 
bution. 


100.0 


3.1 

%.9 

9.0 

7.3 

6.8 

28.1 

'35.6 

8.2 

1.9 

n.6 
1.1 

67.1 

71.9 

31.4 

3.1 

1.4 

8.8 

15.0 

45.6 

19.5 

26.9 

2.7 

1.7 

47.1 


Girls. 


Num- 
ber. 


1,570 


101 

1,469 

163 

130 

58 

453 

383 

118 

18 

11 

8 

1,048 

1,039 

419 

51 

11 

181 

230 

599 

163 

375 

33 

11 

37 


Per  cent 
distri- 
bution. 


100.0 


6.4 
93.6 
10.4 

8.3 

3.7 

28. 9 

'36.6 

7.5 

1.1 
♦1.2 
.5 
66.8 
66.2 
26.7 

3.2 
.7 
11.5 
14.6 
38.2 
10.4 
23.9 

2.1 
.7 

2.4 


1  In  1,081  cases  vision  was  not  tested;  hence  this  number  does  not  include  all  possible  cases  of  defective 
vision. 

2  Per  cent  based  on  2,044  cases  tested,  998  boys  and  1,046  girls. 

'  In  1,279  cases  hearing  was  not  tested;  hence  this  number  does  not  include  all  possible  cases  of  defective 
hearing. 
■•  Per  cent  based  on  1,846  cases  tested,  901  boys  and  945  girls. 

Table  2.— Specified  defects,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination. 


Age  and  sex. 


Both  sexes 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 

108178°— 22 5 


Total 
chil- 
dren. 


With 
anemia. 


Num- 
ber 


3,125 


511 
496 
549 
667 
682 
220 


243 


5 
3 
21 
67 
114 
33 


Under- 
weight (10 

per  cent 
and  over). 


Per    Num- 
cent.    ber. 


1.0 
.6 

3.8 
10.0 
16.7 
15.0 


Per 
cent. 


9.7 


16.6 
11.9 
10.2 
6.6 
7.0 
5.0 


With 

decayed 

teeth. 


Num- 
ber. 


2,021 


108 
218 
364 
533 
59S 
200 


Per 

cent. 


64.7 


21.1 
44.0 
66.3 
79.9 

87.7 
90.9 


With 
defective 
tonsils. 


Num- 
ber. 


1,626 


203 
254 
319 
377 
365 
108 


Per 
cent. 


52.0 


39.7 
51.2 
58.1 
56.5 
53.5 
49.1 


With 

adenoids, 

positive 

and 

suspected. 


Num- 
ber 


1, 257 


68 
123 
208 
363 
389 
106 

65 


Per 

cent. 


40.2 


13.3 
24.8 
37.9 
54.4 
57.0 
48.2 


66 


PHYSICAL  STATUS   OF   PRESCHOOL  CHmDREN. 


Table  2. — Specified  defects,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination — Concluded . 


Age  and  sex. 


Total 
chil- 
dren. 


"With 
anemia. 


Num- 
ber. 


Per 
cent. 


Under 

weight  (10 

per  cent 

and  over). 


Num- 
ber. 


With 
decayed 
teeth. 


Per   Num- 
cent.    ber 


Per 
cent. 


With 
decayed 
tonsils. 


With 

adenoids, 

positive 

and 

suspected. 


Numi 
ber. 


Per   Num- 
cent.    ber 


Per 
cent. 


Boys 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 

Girls 

2  years,  under  3 

3  years,  under  4 

4  years,  under  5 

5  years,  under  6 

6  years,  under  7 

7  years,  under  8 


7.3 


64.8 


836 


53.8 


43.5 


261 
251 
274 
337 
334 
98 

1,570 


2 
1 
10 
32 
53 
15 

130 


.4 
3.6 
9.5 
15.9 
15.3 

8.3 


43 
29 
28 
16 
20 
4 

163 


16.5 
11.6 
10.2 
4.7 
6.0 
4.1 

10.4 


250 
245 
275 
330 
348 
122 


1.2 
.8 

4.0 
10.6 
17.5 
14.8 


16.8 
12.2 
10.2 
8.5 
8.0 
5.7 


57 
115 
1S2 
273 
293 

87 

1,014 


21.8 
45.8 
66.4 
81.0 
87.7 
88.8 

64.6 


110 
132 
163 
198 
183 
50 


42.1 
52.6 
59.5 

58.8 
54.8 
51.0 

50.3 


41 
69 
109 
206 
205 
46 

581 


15.7 
27.5 
39.8 
61.1 
61.4 
46.9 

37.0 


51 
103 
1S2 
260 
305 
113 


20.4 
42.0 
66.2 
78.8 
87.6 
92.6 


93 

122 
156 
179 
182 
58 


37.2 
49.8 
56.7 
54.2 
52.3 
47.5 


27 
54 
99 
157 
184 
60 


10.8 
22.0 
36.0 
47.6 
52.9 
49.2 


Age  and  sex. 


With 
enlarged 
glands. 


Num- 
ber. 


Per 

cent. 


With 
abnormal 

skin 
condition . 


With  bony  and  muscular  defects. 


Total. 


Num- 
ber. 


Per 

cent. 


Num- 
ber. 


Per 
cent. 


Of  rachitic 
origin. 


Num- 
ber. 


Per 

cent. 


Postural. 


Nmn- 
ber. 


Per 
cent. 


Both  sexes 

2  years,  under  3 . 

3  years,  under  4 . 

4  years,  under  5. 

5  years,  under  6 . 

6  years,  under  7 . 

7  years,  under  8. . 

Boys 

2  years,  under  3 . 

3  years,  under  4 . 

4  j-ears,  under  5 . 

5  years,  under  6 . 

6  years,  under  7 . 

7  years,  under  8. 

Girls 

2  years,  under  3 . 

3  years,  under  4 . 

4  years,  under  5 . 

5  years,  under  6. 

6  years,  under  7 . 

7  years,  under  8 . 


29.1 


318 


10.2 


1,308 


41.9 


14.9 


793 


25.4 


66 
76 
150 
250 
265 
101 


12.9 
15.3 
27.3 
37.5 
38.9 
45.9 

31.4 


25 
27 
50 
80 
96 
40 

137 


4.9 
5.4 
9.1 
12.0 
14.1 
18.2 


127 
144 
204 
324 
383 
126 

708 


24.9 
29.0 
37.2 
48.6 
56.2 
57.3 

4.5.6 


54 
42 
73 
106 
148 
44 

304 


10.6 
8.5 
13.3 
1.5.9 
21.7 
20.0 

19.5 


56 
68 
117 
220 
255 
77 

418 


11.0 
13.7 
21.3 
33.0 
37.4 
35.0 

26.9 


31 

45 
82 
136 
148 
47 

419 


11.9 
17.9 
29.9 
40.4 
44.3 
48.0 

26.7 


11 
16 
23 
38 
32 
17 

181 


4.2 
6.4 
8.4 

11.3 
9.6 

17.3 

11.5 


68 
76 
111 
183 
208 
63 

599 


26.1 
30.3 
40.5 
54.3 
62.3 
64.3 

38.2 


163 


12.6 
8.8 
17.5 
22.3 
29.3 
2&6 

10.4 


30 
40 
56 
125 
131 
36 

375 


11.5 
15.9 
20.4 
37.1 
39.2 
36.7 

23.9 


35 
31 
68 
114 
117 
54 


14.0 
12.7 
24.7 
34.5 
33.6 
44.3 


5.6 
4.5 
9.8 
12.7 
18.4 
18.9 


59 
68 
93 
141 
176 
63 


23.6 
27.8 
33.8 
42.7 
50.3 
51.6 


8.4 
8.2 
9.1 
9.4 
14.4 
13.1 


26 

28 
61 
95 
124 
41 


10.4 
11.4 
22.2 
28.8 
3.5.6 
33.6 


GENERAL  TABLES. 


67 


Table  3. — Specified  defects,  by  color  and  nationality  of  mother;  children  2  to  7  years  of 

age  given  physical  examination. 


Total  chil- 
dren. 

Children  of— 

Defect. 

Native  white 
mothers. 

Foreign-born 

white 

mothers. 

Negro 
mothers. 

Moth- 
ers 

whose 
na- 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

tional- 
ity 
was 
not  re- 
port- 
ed.! 

Total 

3,125 

100.0 

1,151 

100.0 

1,896 

100.0 

71 

100.0 

7 

Anemia 

243 
303 

245 
1,626 
1,257 
908 
318 
467 
793 

7.8 
9.7 

7.8 
52.0 
40.2 
29.1 
10.2 
14.9 
25.4 

71 
114 

86 
612 
473 
270 

56 
120 
251 

6.2 
9.9 

7.5 
53.2 
41.1 
23.5 

4.9 
10.4 
21.8 

164 
182 

158 
976 
761 
616 
'250 
336 
505 

8.6 
9.6 

8.3 
51.5 
40.1 
32.5 
13.2 
17.7 
26.6 

8 
7 

1 
34 
22 
20 
12 
10 
37 

11.3 
9.9 

1.4 
47.9 
31.0 
28.2 
16.9 
14.1 
52.1 

Underweight  (10  per  cent  and  over)... 
Eye  disease  or  defect  other  than  of 

4 

Adenoids  (definite  and  suspected) 

Enlarged  glands 

1 
2 

Abnormal  skin  condition 

Bony  defects  of  rachitic  origin 

1 

1  Per  cent  not  shown  where  base  is  less  than  50. 


Table  4.- 


-Specified  defects,  by  earnings  of  chief  breadwinner;  children  2  to  7  years  of  age 
given  physical  examination. 


Earnings  of  chief  breadwinner. 

Defect. 

dren. 

Under  $1,450. 

S  1,450  and 
over. 

Not  re- 
ported. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

Total 

3,125 

100.0 

1,767 

100.0 

1,178 

100.0 

180 

100.0 

Anemia 

243 
303 
245 
1,626 
1,257 
908 
318 
467 
793 

7.8 
9.7 
7.8 
52.0 
40.2 
29.1 
10.2 
14.9 
25.4 

149 
176 
141 
938 
714 
533 
214 
296 
487 

8.4 
10.0 

8.0 
53.1 
40.4 
30.2 
12.1 
16.8 
27.6 

76 
111 

87 
602 
476 
322 

80 
149 
260 

6.5 
9.4 
7.4 
51.1 
40.4 
27.3 
6.8 
12.6 
22.1 

18 
16 
17 
86 
67 
53 
24 
22 
46 

10.0 

8.9 

Eye  disease  or  defect  other  than  of  vision 

Defective  tonsils 

9.4 
47.8 

Adenoids  (definite  and  suspected) 

37.2 

Enlarged  glands 

29.4 

Abnormal  skin  condition 

13. 3 

Bony  defects  of  rachitic  origin 

12.2 

Postural  defects 

25.6 

68 


PHYSICAL,  STATUS  OF   PRESCHOOL   CHILDREN. 


Table  5. — Per  cent  of  children  with  specified  defects,  by  deviation  from  average  weight  for 
height;  children  2  to  7  years  of  age  given  physical  examination. 


Defect. 


Total 
children 


Relation  of  weight  to  height. 


and 
above. 


Below  average. 


Less  than 
7  per 
cent. 


7  per  cent, 

less  than 

10. 


10  per 

cent  and 

over. 


Total 

Anemia 

Eye  disease 

Decayed  teeth 

Naso-pharyngeal  defects 

Defective  tonsils,  no  adenoids — 

Adenoids,  no  defective  tonsils. . . 

Defective  tonsOs  and  adenoids. . . 

Diseased  tonsils 

Other 

Enlarged  glands 

Abdominal  defects 

Defects  of  bony  and  muscular  system 

Bony  defects  of  rachitic  origin. . . 

Postural  defects 


100.0 


100.0 


100.0 


7.8 
5.0 
64.7 
69.0 
22.8 
11.0 
29.3 
13.0 
6.0 
29.1 
14.8 
41.9 
14.9 
25.4 


5.5 
4.4 
66.7 
70.5 
23.1 
11.8 
30.4 
13.0 
5.2 
29.1 
19.5 
37.6 
13.1 
20.4 


7.9 
5.4 
66.9 
70.0 
21.9 
11.8 
29.4 
13.0 
6.9 
29.1 
11.4 
45.2 
16.2 
28.6 


100.0 


10.8 

6.2 

61.0 

64.1 

21.4 

9.0 

28.2 

15.2 

5.6 

30.3 

10.5 

42.1 

14.2 

30.7 


100.0 


13.9 

5.0 

51. 2 

04.0 

26.1 

6.6 

25.1 

10.9 

6.3 

27.4 

12.5 

47.2 

18.8 

28.7 


Table  6. — Specified  skin  diseases,  by  age  and  sex;  children  2  to  7  years  of  age  given  physical 

examination. 


Age  and  sex. 


Both  sexes 

2  years,  under  3., 

3  years,  under  4.. 

4  years,  imder5.. 

5  years,  under  6.. 

6  years,  under  7. . 

7  years,  under  8.. 

Boys 

2  years,  imderS.. 

3  years,  imder4.. 

4  years,  under  5. . 

5  years,  under  6.. 

6  years,  under  7. . 

7  years,  under  8.. 

Girls 

2  years,  under  3. . 

3  years,  under  4.. 

4  years,  under  5.. 

5  years,  iuider6.. 

6  years,  under  7. . 

7  years,  under  8. . 


Total 
chil- 
dren 


3,125 


511 
496 
549 
667 
682 
220 

1,555 


261 
251 
274 
337 
334 


1,570 


250 
245 
275 
330 
348 
122 


Children  with- 


Eczema. 


Num- 
ber. 


Per 
cent. 


Pediculosis. 


Num- 
ber. 


2.6       145      4.6 


Per 

cent. 


Impetigo. 


Num- 
ber 


49 


1.2 
.4 
2.9 
3.1 
4.0 
3.6 

3.2 


3.3 
3.9 

5.7 
4.1 

2.0 


2.5 
2.4 
2.3 
3.3 


1 
1 
3 

15 
5 

10 

110 


.4 
1.2 
2.2 
6.0 
8.2 
13.2 

2.3 


.4 

.4 

1.1 

4.5 

1.5 

10.'2 

7.0 


.4 

2.0 

3.3 

7.6 

14.7 

15.6 


Per 

cent. 


0.3 


Infected 
sores. 


Num- 
ber. 


Per 
cent. 


67       2.1 


32 


2.2 
2.2 
3.1 
1.8 
1.8 
1.8 

2.3 


2.3 
2.4 
2.9 
1.8 
1.8 
3.1 


2.0 
2.0 
3.3 
1.8 
1.7 


Ringworm. 


Num- 
ber. 


29 


Per 
cent, 


1.0 

1.2 

.5 

1.0 


.4 

2.4 

.7 

.9 

1.2 

2.0 


1.6 


.4 
1.2 


Scabies. 


Num- 
ber 


Per 
cent. 


GEISTEEAL  TABLES.' 


69 


1 

•M 

c 

5 

H 

|OiOi 

.-<  -< 

0         to 

|COCO 

.r-<TH 

•     z 

5               "5 

.■^•^ 

§•^2 

I 

i    ^ 

l^^' 

:    8       S 

:^"r-; 

\     j 

t      si 

:c4<N 

■o  . 

-t 

ox) 

£^l 

1 

ife 

,             lO 

'  00  00 

iC^tM 

,           ■* 

•  00 

1,-1,-H 

c 

5         ^ 

1 00  00 

i-l»H 

( 

2       8 

•  xnxa 

?            " 

•(M(M 

K 

;      s? 

|«CO 

IS-^ 

o"  1     «" 

H- 

H- 

c 

3             1005«D  O 

i-^.l 

!     c 

3               t~-00COCO 

•^.'^. 

c 

3            <NO0000 

"=3  ,A 

©  J-  o 

PI 

i 

j               lO  C<i  -h'  -H 

5           toco 

:    8 

t               g^^'^' 

.  ^ 

i     gs  ■  ■ 

1 

C  bi3 

Si: 

5          cDoo  asci 

(N<M 

5        ^f2^^ 

C^(N 

c 

5          (Nmcoeo 

HH    ^ 

c 

^          ^  fM  ■*  -^ 

g 

;      SsS^-" 

^^- 

I         oo 

5             0510 

f             C^~-h" 

h"           ^m' 

d 
o 

tM 

c!.i  d 

c 

3               05^ 

c 

>             OS^ 

c 

5             0 

',     '■3 
1     § 

5  a 

a  OS 

§^.2 

s 

i     s  ■ 

S 

3           oi 
5         a> 

§ 

I       8 

i       <o 

E 

Sc 

(> 

J     g^ 

5          mc^ 

§ 

i       S 

w 

g  o 

1          10 

5       10 

0^ 

^^ 

5~        n 

h"        i-T 

T                      T^ 

a, 

i     c 

a--^^ 

c 

>             «  IM -"I"  ■<><  .-1 

c 

5             (^  10  t^  to -^  1-1 --l 

c 

3              OSOIN— l,-l 

!>>   . 

§i3.2 

§             S"     ■     ■     ■ 

>               lOcO 

1 

?■       8"^  ■  ■  ■ 

c 
a 
"Si 

So 

c^ 

J       ||223«-- 

>                00  ira -<  0  tH  .-H  rH 
)                00iOr-lr-( 

c 

3                  jHtgWC.^ 

g  a 

;§^ 

>                ■* 

S             "3 

o 

c 

r      co" 

,-r 

^- 

"S.i  d 

c 

>           t^  to  lO  .-H  ■<(<  to 

M 

c 

>              00  0  00  CO  10  ■*  Tl  CO 

c 

>             to  ,-1  ,-1  00  CO --H 

rt 

J3 

^^ 

c  >-.  O 

g 

ocgt^^^    • 

s 

I       S'S"-^'^ 

1 

5         g2«5    -uj    • 

f 

03  o^ 

.Six? 

1^1 

1    £ 

qM 

a^ 

(N 

oo«ecocoooor-4t- 

r^  if^  r- 0  r*  CO  1-H  lO 

;     sssss^ 

e^ 

t     -o 

3  £ 

TtlOS  "-H            f-H 

■*C3l 

3 

i-^ 

f 

1       -'■■ 

" 

>. 

"S.J,  d 

c 

T»i  o  OJ  "5  •*  to --lu: 

c 

>              N  W  00  lO  CO  OS  C^  t^ 

c 

>                t*  03  i-t  "3  to  CO 

CO 

gi3.2 

j^^o^rf^-    -^ 

1 

S??j?^'-'S'^  '-^ 

s 

;      Slsss-"^"-^' 

'-'■ 

^43 

H  60 

1^1 

a^ 

u- 

CO  "O  ■*  t^  t>.  o  CO  I- 

lOtOCO        CO 

c 

iii^s^ 

^ 

XJ  "" 

Cs 

t^  Ttl  lO -l*  O  lO        ■* 

IT 

t- 

N 

^ 

aS 

ococo     to 

ir 

iC 

02 

12; -^ 

c 

"-'-''' 

" 

■" 

S.i  d 

c 

CO  t*^H 

c 

010^-H 

c 

toco-< 

rt 

rt  j^- 

•&l 

SS  2 
|3| 

^  ■  ■ 

5 

$-•  •  • 

1 

§  ■  ■ 

S.2 

,S;  bjQ 

i^ 

^ 

N  — IM-Hrt 

ir 

QOtO-H'-l 

c 

^U^f-4 

,_( 

O  °" 

c 

ON 

1? 

s- 

& 

s 

g^ 

e^ 

oo"' 

- 

-*- 

M 

o 

■o 

fl 

03 
i5 

"H 

d 

d 

d 

a 

d 

a 

s 

0 

0 

0 

0 

0 

0 

■a 

o 

1 

•2  8 

•2g 
^5 

d-j3 

at 

|.a 

11 

is 

•2| 

£.3 

dv3 

•s-g  . 

■s-g 

■3'g  . 

a-r3 

■'-'  03 

1.2  ■§13 

"S  ,2  T)  §  « 

03   TO  '0  03   03 

3  §  "2  = 

■§  8  §''S  i 

.2  8a.2  8 

a 

s 

«  ^  C3  tn  03 

M  03  H  w  C3 

0     ■ 

3  • 

w  «  e  M  03 

o 

0 

jq  o'3'H        S 

3 

s 

OS 

o3 

0 

0 

0 

1 

70 


PHYSICAL,   STATUS   OF   PRESCHOOL   CHILDEEN. 


s 
s 
•« 
g 


5cg 


1-^ 


12:'^ 


cOt^  t-  tC  tC  o 
O  00  00  C  t^  'C 


-fC  00  0(N  CO        CO 
5  Tt<  Tj<  t- lO  CO        Cl 


Tii  -xji  CO  oi  ifi  lO      ui 


^COOOOOlN         (N 
<N  (N  C^  CO '^  i-H         Oi 


"^  *^  d  CO  '^  OS  CO 


WCmOCQCOC^         O 


««*<  CO  lO  i-O  lO  CO 

*c4ccco 


(N  CO  CO  t^-^  00 


CO  00  (M  CO  "<*<  O 


^(MC^(N        i-» 


CO  OS  CD  (N  r^  lO      00 

lO  -^  00  O         CO 


00  00  QC  CO  LO  C^ 
"  »—  CO'  -^  "<^  CO 


■^  Oi  y-l  -^  I-*  t^ 


OC  OCOt-I  00  00 


•^  i-O  t>-  -f  OS  -^         00 

l-H    T-1  CO 


iC  00  (N  o  r^  ■<**      "^ 
ri  CO  cot^os  1-1      ci 


OC  OS  -<t«  r- CO  uo      CD 


OS  (N  OOCOCO  00        C<1 
CO  CO  UO  c6t^  CD        t-^ 


OCDC^tMOiO        C<I 
C^  r-t  CO  ■*  »0  tH         1-H 


00  -^  1-*  b-  C^  ic        o 


:go^      »o 


OS  c^  lo  r- 1  w  iri      00 

.-H.-JOSOOCO         CD 


^^  00  CD-^  -^CO        t^ 
COClC^iOCOCS         o 


X  CO  00  CDI>.^H        UO 
CO  ui  iri  06  o  -^       CD 


T-H   .—   — I   ?<1  i-H  O 


rt<00o0CO      ■  O         "^ 


•^'^f  t^Tj*  ! 


C<ICO  (N         i-H 


i-H^CMOD^^C^         O 


-^  Tt^  r-(  CO  t^  CD 


C^  OS  Tt^  00I>-        CO 


1-1  CO  O  CO  CD  l>-         '^ 

CSOOOSIN        i-< 


00  00  CO  CO  CO  i-(         CD 
■  Ci  CO  LO  CO  -^        CM 


C^l  t^  O  00  1-H  Ttt        -^ 


i-O  CO  CM  00'  iC  w         O 
^  ^  CM^  TT  CO         --* 


•<*♦  rr  CO  CO'  LO  CO         »o 


CM  00 ''t^  O  10 -*         O 


•<*<  rt^  CO  ^  CO  OC         "»J< 


»MCMCOt^i.O00        CO         t^t^— '0<— it^ 

^  t-l  CM  CO  -^   r-H 


CM^OOOCMCM 

OS  coooui  »oo6 


CO  lO  CM  OS  00  O 
CM  t-H  CM  t-H  f-H  1-1 


^CO  06  OS  CO  CO 


1-^  OS  CM  1-H  1-1  00 
1-t       CMCOCM 


Tt<  X  T}<  t>.  CM  OS 


^CM—tOi'^CD 


00  CM  COOS '^  O 


^H  i-it^  COCO 


CMCO^OS^OO 


00  00  O  OS  OS  i-O 
'■^COCMCM 


CMCMi-iCOOCO 


^  T-H  00 -^J^  1-1 


000  o  o  Or-- 


CM  CM  -^  CO  CD  10 


OcOcDCMOSCM        O 
lOco  COOS  OS  00        •'J* 


CO  OS  00 --<  CO  00        CO 


00  00  00  OS  OS 


CM  CM  iC  CO  CO 


OC  O:  i-H  CO  OS  b- 


CM  CM  lOCO  -^  »0 


JN,  t^  Tj<  1-4  t^  f* 


OOO'^COtJ*  GC 

'cm     '     'i-J 


LO  ^  CM  O  »-( 


^-^  d 


.-( COOS  r*  CM  o 

1— <  01  ^  CO  «!;  CM 
to  Tji  ic  CO  CO  CM 


^  ■^  'Tfi  t^  yrf  00  O 

CD  ».o  r—  CO  cc  OS       t^ 
CM  CM  CM  CO  CO  »-': 


^  •n' t^  CO  rf^  CM 


CO  '^USOt*  cc 


rt  c3  ^  c3  ^  c3 


CM  CO  '«J'  10  CDt 


O  D  C/  c;  ©  Q> 
-3 --;  X! -TS  TJ  T3 
C  C3  S  ^  C  G 


s    .tii 


©  ®  05  Q) 

d  c  c  a  1 


>!  X  >.  >.  >.  >. 


o  o  a>  o  ffi  o 


CS  C3 

ffl  o 

cot- 


GENERAL  TABLES. 


71 


Table  9. — Relation  of  weight  to  height,  by  age  and  sex;  children  2  to  7  years  of  age  given 

physical  examination. 


Relation  of  weight  to  height  and  sex. 


Both  sexes 

Weight  for  height: 

Average  and  above 

Below  average 

Less  than  7  per  cent  . . 
7  per  cent,  less  than  10 
10  per  cent  and  over  . . 

Boys 

Weight  for  height: 

Average  and  above 

Below  average 

Less  than  7  per  cent. . . 
7  per  cent,  less  than  10. 
10  per  cent  and  over. . . 

Girls 

Weight  for  height: 

Average  and  above 

Below  average 

Less  than  7  per  cent. . . 
7  per  cent,  less  than  10. 
10  per  cent  and  over. . . 


Total  children. 


Num- 
ber. 


3,125 


1,319 

1,806 

1,180 

323 

303 

1,555 


618 
937 
627 
170 
140 

1,570 


701 
869 
553 
153 
163 


Per  cent 
distri- 
bution 


42.2 
57.8 
37.8 
10.3 
9.7 

100.0 


39.7 
60.3 
40.3 
10.9 
9.0 

100.0 


44.6 
55.4 
35.2 
9.7 
10.4 


2  years,  under  3. 


Num- 
ber. 


511 


188 
323 
172 
66 


95 
166 
91 
32 
43 

250 


93 
157 
81 
34 
42 


Per  cent 
distri- 
bution 


100.0 


36.8 
63.2 
33.7 
12.9 
16.6 

100.0 


36.4 
63.6 
34.9 
12.3 
16.5 

100.0 


37.2 
62.8 
32.4 
13.6 
16.8 


3  years,  under  4. 


Num- 
ber. 


194 
302 
184 
59 
59 

251 


Per  cent 
distri- 
bution. 


loao 


39.1 
60.9 
37.1 
11.9 
11.9 

100.0 


94 

37.5 

157 

62.5 

95 

37.8 

33 

13.1 

29 

n.6 

245 

100.0 

100 

40.8 

145 

59.2 

S9 

36.3 

26 

10.6 

30 

12.2 

4  years,  under  5. 


Num- 
ber. 


Per  cent 
distri- 
bution. 


100. 0 


223 

326 

222 

48 

56 

274 


175 
119 

28 
28 

275 


124 
151 
103 
20 

28 


40.6 
59.4 
40.4 
8.7 
10.2 

100.0 


36.1 
63.9 
43.4 
10.2 
10.2 

100.0 


45.1 
54.9 
37.5 
7.3 
10.2 


Relation  of  weight  to  height  and  sex. 


5  years,  under  6. 


Num- 
ber. 


Per  cent 
distri- 
bution 


6  years,  mider  7.  7  years,  under  8. 


Num- 
ber. 


Per  cent 
distri- 
bution. 


Num- 
ber. 


Per  cent 
distri- 
bution. 


Both  sexes - 


667 


100.0 


100.0 


Weight  for  height: 

Average  and  above 

Below  average 

Less  than  7  per  cent 

7  per  cent,  less  than  10. 
10  per  cent  and  over 


Boys. 


284 
383 
277 
62 
44 

337 


42.6 
57.4 
41.5 
9.3 
6.6 

100.0 


320 
362 
239 

75 
48 

334 


Weight  for  height: 

Average  and  above 135 

Below  average 202 

Less  than  7  per  cent 152 

7  per  cent,  less  than  10 j  34 

10  per  cent  and  over |  16 


Gu-ls. 


Weight  for  height: 

Average  and  above 

Below  average 

Less  than  7  per  cent 

7  per  cent,  less  than  10. 
10  per  cent  and  over 


330 


149 
181 
125 

28 
28 


40.1 
59.9 
45.1 
10.1 

4.7 

100.0 


147 
187 
132 
35 
20 


45.2 
54.8 
37.9 

8.5 
8.5 


173 

175 
107 
40 

28 


46.9 
53.1 
35.0 
11.0 
,7.0 

100.0 


44.0 
56.0 
39.5 
10.5 
6.0 

100.0 


49.7 
50.3 
30.7 
11.5 
8.0 


110 
110 


50.0 
50.0 
39.1 
5.9 
5.0 

100.0 


48 
50 
38 
8 
4 

122 


49.0 

51.0 

38.8 

8.2 

4.1 

100.0 


50.8 
49.2 
39.3 
4.1 

5.7 


72 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN. 


Table  10. — Relation  of  weight  to  height,  by  color  and  nationality  of  vwther;  children  2 
to  7  years  of  age  given  -physical  examination. 


Color  and  nationality  of  mother. 


Total 
chil- 
dren. 


Relation  of  weight  to  height. 


Average 
and  above 


Be'ow  average. 


Total. 


Num- 
ber. 


Per 
cent.i 


Num- 
ber. 


Per 

cent.i 


Less  than 
7  per  cent. 


Num- 
ber. 


Per 
cent.i 


7  per  cent, 
less  than  10. 


Num- 
ber. 


Per 
cent. 


10  per  cent 
and  over. 


Num- 
ber. 


Per 
cent.' 


Total. 


3,125    1,319 


42.2    1,806 


57.8 


1,180 


37.8 


323 


10.3 


303 


9.7 


White 

Native , 

Foreign-born , 

Serbo-Croatian. 

Slovak , 

Polish 

Magj'ar 

Italian 

German 

Lithuanian 

All  other 

Negro 

Not  reported 


3,047 

1,284 

42.1 

1,763 

1,151 

466 

40.5 

685 

1,896 

818 

43.1 

1,078 

321 

144 

44.9 

177 

313 

102 

32.6 

211 

224 

90 

40.2 

134 

176 

76 

43.2 

100 

157 

89 

56.7 

68 

139 

58 

41.7 

81 

83 

47 

56.6 

36 

483 

212 

43.9 

271 

71 

33 

46.5 

38 

7 

2 

5 

57.9 
59.5 
56.9 
55.1 
67.4 
59.8 
56.8 
43.3 
58.3 
43.4 
56.1 
53.5 


1,150 

439 

711 

121 

137 

89 

66 

52 

49 

22 

175 

26 

4 


37.7 
38.1 
37.5 
37.7 
43.8 
39.7 
37.5 
33.1 
35.3 
26.5 
36.2 
36.6 


317 

132 

185 

28 

40 

22 

23 

7 

11 

8 

46 

5 

1 


10.4 

11.5 
9.8 
8.7 

12.8 
9.8 

13.1 
4.5 
7.9 
9.6 
9.5 
7.0 


296 

114 

182 

28 

34 

23 

11 

9 

21 

6 

50 

7 


9.7 
9.9 
9.6 
8.7 

10.9 

10.3 
6.3 
5.7 

15.1 
7.2 

10.4 


1  Not  shown  where  base  is  less  than  50. 

Table  11. — Prevalence  of  specified  defects,  by  deviation  from  average  weight  for  height; 
children  2  to  7  years  of  age  given  physical  examination. 


Deviation  from  aver- 
age    weight     for 
height.  I 

Total 
i  chil- 
dren. 

With 

decayed 

teeth. 

With 
adenoids. 

With 
diseased 
tonsils. 

With 
postural 
defects. 

With  bony 

defects  of 

rachitic 

origin. 

With 
anemia. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Total 

3,125 

2,021 

64.7 

1,050 

33.6 

406 

13.0 

885 

28.3 

467 

14.9 

243 

7.8 

4i  pounds  or  more 
below  average 

3i  and  4  pounds  be- 
low average 

3  pounds  below  aver- 

84 

99 

110 

126 

177 

188 

255 

241 
270 

234 

259 

217 

185 

146 

119 

159 

207 
49 

51 

68 

69 

72 

100 

126 

158 

154 
185 

144 

160 

135 

114 

96 

80 

114 

153 
42 

60.7 

68.7 

62.7 

57.1 

56.5 

67.0 

62.0 

63.9 
68.5 

61.5 

61.8 

62.2 

61.6 

65.8 

67.2 

71.7 

73.9 

85.7 

31 
35 
37 
33 

55 
56 

74 

85 
88 

84 

93 

70 

59 

51 

41 

53 

89 
16 

36.9 

35.4 

33.6 

26.2 

31.1 

29.8 

29.0 

35.3 
32.6 

35.9 

35.9 

32.3 

31.9 

34.9 

34.5 

33.3 

43.0 
32.7 

12 

19 

20 

23 

10 

22 

32 

39 
30 

22 

32 

25 

19 

18 

21 

23 

28 
11 

14.3 

19.2 

18.2 

18.3 

5.6 

11.7 

12.5 

16.2 
11.1 

9.4 

12.4 

11.5 

10.3 

12.3 

17.6 

14.5 

13.5 

22.4 

33 

30 

41 

37 

50 

59 

79 

73 
71 

62 

70 

51 

46 

40 

37 

39 

53 
14 

39.3 

30.3 

37.3 

29.4 

28.2 

31.4 

31.0 

30.3 
26.3 

26.5 

27.0 

23.5 

24.9 

27.4 

31.1 

24.5 

25.6 
28.6 

17 

23 

19 

19 

20 

32 

42 

43 
39 

26 

40 

36 

28 

17 

16 

21 

20 
9 

20.2 

23.2 

17.3 

15.1 

11.3 

17.0 

16.5 

17.8 
14.4 

11.1 

15.4 

16.6 

15.1 

11.6 

13.4 

13.2 

9.7 
18.4 

20 

15 

17 

16 

15 

21 

17 

16 
14 

13 

18 

13 

10 

10 

6 

4 

14 
4 

23.8 
15.2 
15.5 

2i     pounds     below 

12.7 

2  pounds  below  aver- 

8.5 

IJ     pounds     below 

11.2 

1  pound  below  aver- 

6.7 

J  poimd  below  aver- 

6.6 

5.2 

i  pound  above  aver- 
age   

5.6 

1  pound  above  aver- 

6.9 

U     pounds     above 

6.0 

2  pounds  above  aver- 
age. . 

5.4 

2J     poimds    above 

6.8 

3  pounds  above  aver- 
age   

5.0 

3J    and    4    pounds 
above  average 

4J  pounds  or  more 
above  average 

Not  classified 

2.5 

6.8 
8.2 

1  In  tills  table,  the  average  weights  for  height  of  the  Children's  Year  series  were  taken  as  standard.    See 
Statures  and  Weights  of  Children  under  Six  Years  of  Age,  Children's  Bureau  Publication  No.  87,  p.  29. 


GENERAL   TABLES, 


73 


Tablf.   12. — Annual  earnings  of  chief  breaduinner,   by  color  and  nativity  of  mother; 
children  S  to  7  years  of  age  given  physical  examination. 


Annual  earnings  of  chief 
breadwinner. 


Total 3.125  '100.0  '3,047   100.0 


Total 
children. 


Color  and  nati\-itv  of  mother. 


Total. 


Xative. 


Num- 
ber. 


Per 
cent 
dis- 
tribu- 
tion. 


Per 

i  ber.  'tribu- 
1  I  tion. 


Under  S650 

$650-$849 

$850-81.049 

Sl,050-$1,249 

$1,25(>-$1,449 

$1,450-81,849 

$1,850-82,249 

$2,250  and  over 

No   chief  breadwinner   and 

earnings 

Not  reported 


110 
240 
412 
491 
456 
613 
262 
303 

58 
180 


3.5 

13^2 
15.7 
14.6 
19.6 
8.4 
9.7 

1.9 


102 
229 
396 
477 
448 
606 
259 
300 

57 
173 


3.3 

7.5 
13.0 
15.7 
14.7 
19.9 
8.5 
9.8 

1.9 
5.7 


Num- 
ber. 


Per 

cent 
dis- 
tribu- 
tion. 


1,151    100.0 


19 
34 
69 
146 
154 
313 
151 
194 

19 
52 


1.7 
3.0 
6.0 
12.7 
13.4 
27.2 
13.1 
16.9 

1.7 
4.5 


Foreign 
born. 


Num- 
ber. 


I  Per 

cent 

dis- 

.  tribu- 

I  tion. 


1.896   100.0 


83 
195 
327 
331 
294 
293 
108 
106 

38 
121 


4.4 
10.3 
17.2 
17.5 
15.5 
15.5 

5.7 


2.0 
6.4 


Negro. 


Num- 
ber. 


Per 

cent 
dis- 
tribu- 
tion. 


11.3 

15.5 

21.1 

19.7 

11.3 

8.5 

1.4 

1.4 

1.4 

S.5 


Not 
re- 
port- 
ed.! 


1  Per  cent  distribution  not  shown  where  base  is  less  than  50. 


APPENDIX    B.    RESULTS    OF    PHYSICAL    EXAMINATIONS    OF 
CHILDREN  UNDER  TWO  YEARS  OF  AGE. 

Source  of  material. 

During  the  conferences  held  in  connection  with  this  study,  exami- 
nations were  made  of  994  infants,  the  same  standards  being  observed 
in  making  the  physical  examinations  and  tabulations  as  were  used 
in  the  preschool  group.  Since  rather  interesting  differences  in  the 
incidence  of  defects  in  the  two  age  groups  were  found,  a  brief  state- 
ment of  the  results  is  liere  appended. 

Findings  in  general. 

Of  the  entire  group  of  994  infants,  28.3  per  cent  were  found  to  have 
no  defects;  less  than  half  (40.2  per  cent)  of  those  under  6  months 
of  age  were  without  defect.  More  boys  than  girls  showed  defects, 
as  only  12  per  cent  of  the  former  were  without  defect  in  contrast  to 
46.4  per  cent  of  the  latter. 

Table  I. — Number  of  defects,  by  age  and  sex;  children  under  2  years  of  age  given  physical 

examination. 


Total 
children. 

Under 

6 
months. 

6  months, 
under 
1  year. 

1  year, 

under 

IJ  years. 

IJ  years, 
under 
2  years. 

Number  of  defects,  and  sex. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
bu- 
tion. 

994 

100.0 

214 

100.0 

278 

100.0 

245 

100.0 

257 

100.0 

With  defects 

713 
676 
318 
205 
114 
39 
34 
3 
281 

524 

71.7 
68.0 
32.0 
20.6 
11.5 
.S.9 
3.4 
.3 
28.3 

100.0 

128 
128 
87 
31 
6 
4 

59.8 
59.8 
40.7 
14.5 
2.8 
L9 

182 

179 

104 

52 

18 

5 

3 

65.5 
64.4 
37.4 
18.7 
6.5 
1.8 
1.1 

191 
180 
69 
61 
39 
11 
11 

78.0 
73.5 
28.2 
24.9 
15.9 
4.5 
4.5 

212 
189 
58 
61 
51 
19 
20 
3 
45 

137 

82.5 

Less  than  5 

73.5 

1 

22.6 

2 

23.7 

3 

19.8 

4     

7.4 

5to9  . 

7  8 

10  to  14 

1.2 

Without  defects 

86 
113 

40.2 
100.0 

96 
146 

34.5 
100.0 

54 
128 

22.0 
100.0 

17.5 

Boys 

100.0 

With  defects.. 

461 
435 
188 
137 
81 
29 
24 
2 
63 

470 

88.0 
83.0 
35.9 
26.1 
15.5 
5.5 
4.6 
.4 
12.0 

100.0 

96 
96 
61 
26 
6 
3 

85.0 
85.0 
54.0 
23.0 
5.3 
2.7 

127 
125 
65 
41 
14 
5 
2 

87.0 

85.6 

44.5 

28.1 

9.6 

3.4 

1.4 

115 
106 
35 
36 

28 
7 
9 

89.9 
82.8 
27.3 
28.1 
21.9 
5.5 
7.0 

123 
108 
27 
34 
33 
14 
13 
2 
14 

120 

89.8 

78.8 

1.. 

19.7 

2 

24.8 

3... 

24.1 

4 

10.2 

5to9... 

9.5 

10tol4 

1.5 

Without  defects 

17 
101 

15.0 
100.0 

19 
132 

13.0 
100.0 

13 
117 

10.2 
100.0 

10.2 

Girls 

100.0 

With  defects 

252 

241 

130 

68 

33 

10 

10 

1 

218 

53.6 
51.3 
27.7 
14.5 
7.0 
2.1 
2.1 
.2 
46.4 

32 

32 

26 

5 

31.7 

31.7 

25.7 

5.0 

65 
54 
39 
11 

4 

41.7 
40.9 
29.5 
8.3 
3.0 

76 
74 
34 
25 
11 
4 
2 

65.0 
63.2 
29.1 
21.4 
9.4 
3.4 
1.7 

89 
81 
31 

27 
18 
5 

7 

1 

31 

74.2 

Less  than  5 

67.5 

1 

25.8 

2 

22.5 

3 

15.0 

4 

1 

1.0 

4.2 

5to9... 

1 

.8 

5.8 

10 

.8 

Without  defects 

69 

68.3 

77 

58.3 

41 

35.0 

25.8 

75 


76 


PHYSICAL   STATUS  OF   PRESCHOOL  CHILDREN. 


An  analysis  of  the  kinds  of  defects  as  given  in  Table  II  shows 
a  fairly  even  distribution  as  to  sex  except  in  defects  of  the  genitalia, 
where  a  marked  difference  between  boys  and  girls  occurs. 

Table  II. — Prevalence  of  disease  or  defects,  by  sex;  children  under  2  years  of  age  given 

physical  examination. 


Disease  or  defect. 


Total. 


AVithoiit  defect 

With  disease  or  defect 

General: 

Underweight  (10  per  cent  and  over) 

Anemia 

Head 

Abnormal  shape . . '. 

Open  fontanel  (children  1^  to  2  years  of  a| 
Eyes: 

Diseases  and  defects  other  than  of  vision. 

Conjunctivitis 

Blepharitis 

Stye 

Ptosis 

Corneal  opacities 

Strabismus 

Blindness  (one  eye) 

Ears 


Acute  otorrhea... 
Chronic  otorrhea. 

Mouth 

Decayed  teeth . . . 
Malocclusion . . . . 


Xaso-pharynx 

Defective  tonsils 

Adenoids  (definite) 

Adenoids  (suspected) 

Glands: 

Enlarged  or  greatly  enlarged 

Submaxillary 

Cervical . . . ." 

Axillary 

Inguinal 

Heart 

Heart  disease 

(I  uestionable  heart  disease 

Lungs 

Lung  disease 

Questionable  lung  disease 

Skin 

Eczema 

Impetigo 

Infected  sores 

Ringworm 

Scars 

Abdomen 

Distended  abdomen 

Enlarged  liver 

Hernia 

Bony  and  muscular  system 

Beaded  ribs 

Pigeon  breast 

Harrison's  groove 

Enlarged  epiphyses 

Roimd  shoulders 

Winged  seapul--p 

Lordosis 

Knock-knee 

Bowlegs 

Clubfeet 

Arthritis 

Paralysis 

Mentality 

Defect  apparent 

Defec  t  suspected 

Genitalia:  Boys 

Prepucialdefects 

Defects  other  than  those  of  prepuce. 
Genitaha:  Girls: 

Vaginal  discharge 


Both  sexes. 


Num- 
ber. 


2S1 
713 

262 
22 

172 
25 
49 

23 

3 

2 

1 

2 

2 

13 

1 

8 

2 

6 

26 

16 

12 

225 

182 

22 

31 

38 
16 
22 
1 
5 
3 
1 
2 


26 
14 
2 
10 
1 
2 
150 
121 
1 

as 

135 
11 
2 
10 
8 
3 
1 
4 
1 

121 
2 
2 
1 
7 


Per 

cent. 


28.3 
71.7 

26.4 
2.2 

17.3 
2.5 
4.9 

2.3 

.3 

.2 

.1 

.2 

.2 

1.3 

.1 

.8 

.2 

.6 

2.6 

1.6 

1.2 

22.6 

18.3 

2.2 

3.1 

3.8 

1.0 

2.2 

.1 

.5 

.3 

.1 

.2 

.9 

.4 

.5 

2.6 

1.4 

.2 

1.0 

.1 

.2 

15.1 

12.2 

.1 

3.8 

13.6 

1.1 

.2 

1.0 

.8 

.3 

.1 

.4 

.1 

12.2 

.2 

.2 

.1 

.7 

.2 

.5 


Boys. 


Num- 
ber. 


524 


63 
461 


152 
13 


6 

15 

10 

5 

129 

101 

17 

17 

23 
9 

14 
1 
2 
2 
1 
1 
7 
4 
3 

14 
7 
2 
5 
1 
1 

71 

56 
1 

19 

81 
7 
2 
8 
5 
2 
1 
3 
1 

72 
1 
2 
1 
4 
2 
2 
374 
371 
7 


Per 

cent. 


12.0 
88.0 

29.0 
2.5 

17.0 
3.1 

4.8 

2.7 


1.5 


1.0 


1.0 
2.9 
1.9 
1.0 
24.6 
19.3 
3.2 
3.2 

4.4 

1.7 

2.7 

.2 

.4 

.4 

.2 

.2 

1.3 

.8 

.6 

2.7 

1.3 

.4 

1.0 

.2 

.2 

13.5 

10.7 

.2 

3.6 

15.5 

1.3 

.4 

1.5 

1.0 

.4 

.2 

.6 

.2 

13.7 

.2 

.4 

.2 

.8 

.4 

.4 

71.4 

70.8 

1.3 


Num- 
ber. 


EXAMINATIOlSr   OF  CHILDREN  UNDER  TWO   YEARS  OF   AGE. 


77 


Irrespective  of  age,  the  average  number  of  defects  of  all  infants 
examined  was  2.2  for  boys  and  1.9  for  girls. 

The  incidence  of  defects  according  to  age  increased  steadily  in 
both  sexes  from  6  months  to  2  years,  but  the  rate  of  increase  was 
much  higher  in  girls.  For  instance,  85  per  cent  of  the  boys  under 
6  months  of  age  had  defects,  in  contrast  to  31.7  per  cent  of  the  girls; 
while  at  2  years  of  age  the  defects  had  increased  to  89.8  per  cent 
and  74.2  per  cent  for  boys  and  girls  respectively. 

Height  and  weight. 

The  average  heights  and  weights  of  all  white  infants  are  recorded 
by  months  in  Text  Table  IV.  As  in  the  case  of  the  preschool  child, 
these  averages  are  somewhat  lower  throughout  than  those  used  as 
standards  in  the  examinations. 

Nutrition. 

More  than  a  quarter  (26.4  per  cent)  of  all  children  under  2  years 
of  age  were  more  than  10  per  cent  below  average  weight  for  height, 
in  contrast  with  9.7  per  cent  of  the  children  2  to  7  years  of  age. 
This  marked  difference,  in  the  two  homogeneous  groups  classified 
by  age,  rather  suggests  that  a  range  greater  than  10  per  cent  below 
average  weight  for  height  would  be  a  fairer  standard  during  infancy. 

The  age  group,  6  months  to  1  year,  showed  the  highest  per  cent 
(14)  graded  "excellent"  as  to  nutrition,  and  the  higher  age  group, 
1  to  H  years,  had  the  highest  per  cent  (35.9)  underweight.  In 
fact,  the  proportion  of  childi'en  10  per  cent  or  more  below  the  average 
weight  for  height  increased  steadily  with  age  up  to  18  months; 
but  in  the  6  month  period  following,  a  decidedly  better  condition 
was  apparent,  only  21  per  cent  of  these  children  being  10  per  cent 
or  more  underweight. 

Table  III. — Grade  of  nutntion,   by  age  and  sex;  children  under  2  years  of  age  given 

physical  examination. 


Age  and  sex. 


Both  sexes 

Under  6  months 

6  months,  under  1  year 
1  year,  under  U  years.  . 
U' years,  under  2" years. 

Boys 

Under  6  months 

6  months,  under  1  year 
1  year,  under  1|  years., 
li  years,  under  2  years. 

Girls 

Under  6  months 

6  months,  under  1  year 
1  year, under  U  years.. 
li  years,  under  2  years. 


Total 
chil- 
dren. 

Grade  of  nutrition. 

Excellent 

Good. 

Poor. 

Very  poor. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 
cent. 

Num- 
ber. 

Per 

cent. 

Num- 
ber. 

Per 

cent. 

994 

94 

9.5 

638 

64.2 

242 

24.3 

20 

2.0 

214 
27S 
245 
257 

524 

10 
39 
20 
25 

61 

4.7 
14.0 
8.2 
9.7 

11.6 

159 
164 
137 
178 
311 

74.3 
59.0 
55.9 
69.3 

59.4 

38 
72 
S5 
47 

141 

17.8 
25.9 
34.7 

18.3 

26.9 

7 
3 
3 

7 

11 

3.3 
1.1 
1.2 
2.7 

2.1 

113 
146 
128 
137 

470 

6 
28 
12 
15 

33 

5.3 
19.2 

9.4 
10.9 

7.0 

79 
75 
65 
92 

327 

69.9 
51.4 
50.8 
67.2 

69.6 

24 
41 
50 
26 

101 

21.2 
28.1 
39.1 
19.0 

21.5 

4 
2 

1 
4 

9 

3.5 

1.4 

.8 

2.9 

1.9 

101 
132 
117 
120 

4 
11 

8 
10 

4.0 
8.3 
6.8 
8.3 

80 
89 
72 
86 

79.2 
67.4 
61.5 
71.7 

14 
31 
35 
21 

13.9 
23.5 
29.9 
17.5 

3 

1 
2 
3 

3.0 

.8 

1.7 

2.5 

78 


PHYSICAL,  STATUS  OF  PRESCHOOL.  CHILDREN". 


A  table  showing  the  amount  of  deviation  from  average  weight  for 
height  in  children  under  2  years  of  age  is  given  for  purposes  of  com- 
parison with  the  preschool  group. 

Table  IV. — Deviation  from  average  weight  for  height,  by  age  and  sex;  children  xcnder  2 
years  of  age  given  physical  examination. 


Deviation  from  average  weight 
for  height. 


Both  sexes . 


Average  and  above 

Below  average 

Less  than  7  per  cent 

7  per  cent,  less  than  10. . 
10  per  cent  and  over 


Total 
children. 


Num- 
ber. 


994 


307 
6S7 
279 
146 
262 


Boys. 


Average  and  above 

Below  average 

Less  than  7  per  cent 

7  per  cent,  less  than  10. 
10  per  cent  and  over 


Girls. 


Average  and  above 

Below  average 

Less  than  7  per  cant 

7  per  cent,  less  than  10. 
10  per  cent  and  over 


165 
359 
139 
68 
152 

470 


142 
328 
140 
78 
110 


Per 
cent 

dis- 
tribu- 
tion. 


100.0 


30.9 
69.1 
28.1 
14.7 
26.4 

100.0 


31.5 

68.5 
26.5 
13.0 
29.0 

100.0 


30.2 
69.8 
29.8 
16.6 
23.4 


Under  6 

months. 


Num- 
ber. 


214 


96 
118 
49 
24 
45 


42 
71 
29 
14 

28 

101 


Per 

cent 
dis- 
tribu- 
tion. 


100.0 


44.9 
55.1 
22.9 
11.2 
21.0 

100.0 


37.2 
62.8 
25.7 
12.4 
24.8 

100.0 


53.5 
46.5 
19.8 
9.9 
16.8 


6  months,  less 
than  1  year 


Num- 
ber. 


278 


86 
192 
73 
44 
75 


Per 

cent 
dis- 
tribu- 
tion. 


100.0 


30.9 
69.1 
26.3 

15.8 
27.0 

100.0 


1  year,  less 
than  l\  years. 


Num- 
ber. 


245 


57 
188 
63 
37 


34.9 
65.1 
19.9 
15.8 
29.5 

100.0 


26.5 
73.5 
33.3 
15.9 
24.2 


100 
34 
15 
51 


Per 
cent 

dis- 
tribu- 
tion. 


100.0 


11  years,  less 
than  2  years. 


Num- 
ber. 


257 


23.3 
76.7 
25.7 
15.1 
35.9 

100.0 


21.9 
78.1 
26.6 
11.7 
39.8 

100.0 


189 
94 
41 
54 


ai.8 
75.2 
24.8 
18.8 
31.6 


Per 

cent 
dis- 
tribu- 
tion. 


100.0 


26.5 
73.5 
36.6 
16.0 
21.0 

100.0 


32.1 
67.9 
34.3 
11.7 
21.9 

100.0 


20.0 
80.0 
39.2 
20.8 
20.0 


Anemia. 

Of  the  children  under  2  years  of  age,  only  2.2  per  cent  showed  suf- 
ficient pallor  to  be  considered  anemic.  Pallor  increased  with  age,  as 
did  the  number  of  defects,  and  was  more  common  in  boys  than  in 
girls.     The  percentage  was  also  higher  in  underweight  children. 

Vaccmation. 

Only  24,  or  2.4  per  cent,  of  the  children  under  2  years  of  age  had  been 
vaccinated. 

Head. 

Measurements  showed  only  13  heads  of  abnormal  size,  7  small  and 
6  large,  in  the  994  children  of  this  age  group,  a  percentage  of  1.3. 
Special  attention  was  given  to  the  palpation  of  fontanels.  Four 
cases  of  completely  closed  fontanels  were  noted  in  infants  under  6 
months,  and  15  in  the  period  6  months  to  1  year.  There  were  49 
cases  of  open  fontanel  in  infants  between  18  months  and  2  years  of 
age. 

Eyes. 

Obviously,  it  was  impossible  to  obtain  data  regarding  vision  in  this 
group;  but  23  mfants,  or  2.3  per  cent,  showed  eye  defects,  the  pro- 


EXAMINATIOlSr  OF  CHILDEEX  UNDER  TWO  YEARS  OF  AGE. 


79 


portion  steadily  increasing  with  age  from  0.9  per  cent  among  infants 
under  6  months  to  3.1  per  cent  among  those  1^  to  2  years  of  age. 

Ears. 

Ear  defects  m  this  group  of  infants  were  confined  to  8  cases  of 
otorrhea. 

Mouth. 

A  careful  examination  of  the  mouths  revealed  little  of  significance 
beyond  the  fact  that  only  5  infants,  or  2.3  per  cent  of  those  under 
6  months  of  age,  had  one  or  more  teeth,  while  11.2  per  cent  had  com- 
pleted teething  under  2  years  of  age.  Sixteen  infants  (2.4  per  cent) 
18  months  of  age  or  over  had  decayed  teeth,  and  12  cases  (1.2  per 
cent)  of  malocclusion  were  found. 

Nasopharynx. 

The  most  common  defects  of  infancy,  as  of  the  preschool  age,  were 
those  of  the  nasopharynx,  although  these  defects  were  about  one- 
third  as  prevalent  in  infancy  as  in  the  preschool  period.  Boys 
slightly  predominated  in  all  types  of  nasopharyngeal  defects,  show- 
ing 24.6  per  cent  in  contrast  to  20.4  per  cent  among  the  girls.  The 
incidence  of  nasopharyngeal  defects  among  infants  under  6  months 
of  age  was  noticeably  slight,  but  a  marked  and  gradual  increase  in 
the  number  of  defects  with  age  was  found. 

Table  V. — Nasopharyngeal  dejects,  by  age  and  sex;  children  vnder  2  years  of  age  given 

2)hysical  examination . 


Age  and  sex. 


Total 
chil- 
dren. 


With  mouth 
breathing. 


Num- 
ber. 


Per 
cent. 


With  high- 
arch  palate. 


Num- 
ber. 


Per 
cent. 


With  defec- 
tive tonsils. 


Num- 
ber. 


Per 
cent. 


With  ade- 
noids. 


Num- 
ber. 


Per 
cent. 


Both  sexes 

Under  6  months 

6  months,  under  1  year 
1  year,  under  IJ  years.. 
IJ  years,  under  2  years. 

Boys 

Under  6  months 

6  months,  under  1  year 
1  year,  under  U  years.. 
IJ  years,  under  2  years. 

Girls 

Under  6  months 

6  months,  under  1  year 
1  year,  under  li  years.. 
1§  years,  under  2  years. 


214 
278 
245 
257 


113 

146 
128 
137 


101 
132 
117 
120 


5.5 


30 


3.0 


18.3 


3.6 

7.8 
10.1 


.5 
2.2 
4.5 

4.7 

3.1 


4.7 
10.8 
24.5 
31.9 

19.3 


4.8 
8.6 
11.7 


2.7 
4.7 
3.6 

3.0 


4.4 
11.0 
25.0 
35.0 

17.2 


2.3 

6.8 
8.3 


1.5 
4.3 

5.8 


5.0 
10.6 
23.9 
28.3 


53 


4.0 
6.9 
9.7 

6.5 


5.5 
8.6 
10.9 

4.0 


2.3 
5.1 

8.3 


80 


PHYSICAI.  STATUS   OF   PRESCHOOL   CHILDREN. 


Mouth  breathing  mcreased  from  3.6  per  cent  in  the  6  months  to  1 
year  period  to  10.1  per  cent  in  the  18  months  to  2  years  period. 

High-arch  palate  showed  a  gradual  development  after  6  months 
of  age,  the  majority  of  cases  being  pronounced  enough  for  recording 
only  after  1  year  of  age. 

Tonsils. — Enlargement  of  tonsils  increased  with  age  from  4.7  per 
cent  under  6  months  to  31.9  per  cent  from  18  months  to  2  years. 
To  what  extent  the  so-recorded  '' enlarged  tonsils"  may  have  been  a 
normal  hj^erplasia  of  lymphoid  tissue  needs  to  be  verified  by  further 
observations;  but  only  1  infant  in  the  group  was  considered  to 
have  greatly  enlarged'  tonsils  and  only  1  had  diseased  tonsils. 

Removal  of  tonsils  was  advised  in  onl}^  4  cases  of  the  182  defective, 
3  of  these  being  accompanied  by  adenoids.  ^ 

Adenoids. — The  prevalence  of  adenoids  increased  with  age,  even 
during  the  period  of  infancy.  Adenoids  were  definitely  diagnosed  in 
22  cases  (2.2  per  cent),  and  sjmiptoms  such  as  mouth  breathing  and 
high-arch  palate  led  to  a  diagnosis  of  "suspected  or  probable"  ade- 
noids in  31  cases  (3.1  per  cent);  thus  the  number  of  infants  having 
definite  or  probable  adenoids  amounted  to  5.3  per  cent. 

Removal  of  adenoids  was  recommended  in  a  total  of  9  cases,  6 
being  combmed  with  defective  tonsils.  Only  1  case  of  adenoids 
requiring  removal  was  found  in  a  child  under  1  year  of  age. 

Glands. 

In  66  per  cent  of  the  entire  group  of  infants  the  glands  were  not 
even  "palpable,"  and  only  3.8  per  cent  had  actually  "enlarged" 
glands. 

Table  YI. — Condition  of  tonMls,  by  age;  children  under  2  years  of  age  given  physical 

examination. 


' 

Total 
children. 

Under  6 
montlis. 

6  months, 
under  1  year. 

1  year,  under 
IJ  years. 

IJ  years,under 
2  years. 

Condition  of  tonsils. 

Num- 
ber. 

Per 

cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
lui- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
bu- 
tion. 

Num- 
ber. 

Per 
cent 
distri- 
bu- 
tion. 

Total 

994 

100.0 

214 

100.0 

278 

,100.0 

245 

100.0 

257 

100.0 

811 

1 

182 

180 

1 

1 

81.6 

.1 

18.3 

18.1 

.1 

.1 

204 

95.3 

248 

89.2 

185 

75.5 

174 

1 

82 

81 

1 

67.7 

Removed,  not  defective 

.4 

10 
10 

4.7 
4.7 

30 
29 

10.8 
10.4 

60 
60 

24.5 
24.5 

31.9 

Enlarfted  onl v 

31.5 

Great  ly  enlarged  only 

Diseased  and  enlarged 

.4 

1 

.4 

That  the  size  of  the  glands  gradually  but  markedly  increased  with 
age  is  shown  by  the  percentage  "palpable,"  as  follows:  7.9  per  cent 
under  6  months,  25.5  per  cent  from  6  months  to  a  year,  38.4  per  cent 
from  1  year  to  18  months,  and  45.9  per  cent  from  18  months  to  2 
years. 


EXAMINATION   OF   CHILDREN   UNDER  TWO   YEARS  OF   AGE. 


81 


Table  VII. — Condition  of  glands,  by  age  and  sex;  children  under  2  years  of  age  given 

physical  examination. 


Total 
children. 

Under  6 
months. 

6  months,  un- 
der 1  year. 

1  year,  under 
li  years. 

ih  years,  un- 
der 2  years. 

CcHiditlon  of  glands,  and  sex. 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 

cent 
dis- 
tribu- 
tion. 

Num- 
ber. 

Per 
cent 
dis- 
tribu- 
tion. 

Both  sexes 

994 

100.0 

214 

100.0 

278 

100.0 

245 

100.0 

257 

100.0 

Glands: 

Normal 

656 
300 

38 

21 

17 

524 

66.0 
30.2 

3.8 

2.1 

1.7 

100.0 

195 
17 

2 

1 

1 

113 

91.1 
7.9 

.9 

.5 

.5 

100.0 

206 
71 

1 

74.1 
25.5 

.4 

141 
94 

10 

2 

8 

128 

57.6 
38.4 

4.1 

.8 

3.3 

100.0 

114 
118 

25 

18 

7 

137 

44.4 

Palpable 

45.9 

Enlarged  and  greatly  en- 
larged  

9.7 

With  associated  infec- 

7.0 

Without  associated  in- 
fection   

1 
146 

.4 
100.0 

2.7 

Boys 

100.0 

Glands: 

Normal          

325 
176 

23 

12 

11 

470 

62.0 
33.6 

4.4 

2.3 

2.1 

100.0 

101 
11 

1 

89.4 
9.7 

.9 

104 
41 

1 

71.2 
28.1 

.7 

67 
55 

6 

1 

5 

117 

.52.3 
43.0 

4.7 

.8 

3.9 

100.0 

53 
69 

15 

11 

4 

120 

38.7 

Palpable 

50.4 

Enlarged  and  greatly  en- 
larged  

10.9 

With  associated  infec- 

8.0 

Without  associated  in- 
fection   

1 
101 

.9 
100.0 

1 
132 

.7 
100.0 

2.9 

Girls 

100.0 

Glands: 

331 

124 

15 
9 
6 

70.4 
26.4 

3.2 

1.9 

1.3 

94 
6 

1 

1 

93.1 
5.9 

1.0 

1.0 

102 
30 

77.3 
22.7 

74 
39 

4 

1 
3 

63.2 
33.3 

3.4 

.9 
2.6 

61 
49 

10 
3 

50.8 

Palpable 

40.8 

Enlarged  and  greatly  en- 

S.3 

With  associated  infec- 
tion 

5  8 

Without  associated  in- 

2.5 

Heart. 

Only  one  case  of  positive  organic  cardiac  disease  and  two  question- 
able cases  were  found  in  the  total  of  994  infants. 

Lungs. 

The  slight  incidence  of  respiratory  disease  in  this  group  of  infants 
is  interesting,  as  shown  by  only  four  positive  diagnoses  and  five 
questionable  cases. 

Skin. 

A  comparatively  small  percentage  of  infants  showed  any  abnormal 
skin  condition — only  26,  or  2.6  per  cent. 

Abdomen. 

Distended  abdomen  was  found  in  121  cases,  or  12.2  per  cent,  this 
condition  being  slightly  more  prevalent  among  girls. 

The  presence  of  hernia  was  noted  in  3.8  per  cent  of  the  group. 
In  both  sex  groups  umbilical  hernias  predominated.  Inguinal  hernia 
was  observed  in  7  cases,  of  which  6  were  boys.  The  largest  number 
of  hernise  by  age  was  fomid  in  the  18  months  to  2  years  groups. 

Enlarged  liver  occurred  in  the  case  of  one  boy. 
108178°— 22 6 


82 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN, 


Bony  and  muscular  system. 

Positive  signs  ^  upon  which  definite  diagnoses  of  rickets  were 
based  were  found  in  22  cases  (2.2  per  cent).  Fifty-three  additional 
cases  having  one  or  more  suggestive  signs  were  recorded  "probably 
rachitic."  ^  No  cases  were  noted  in  the  group  under  6  months  of  age; 
7  of  the  children  classified  as  rachitic  were  between  6  months  and 
1  year,  9  were  between  1  year  and  1^  years,  and  59  (78.7  per  cent 
of  all  those  with  rickets)  were  over  18  months. 

Of  the  rachitic  children  12.1  per  cent  had  defective  tonsils,  as 
compared  with  6.6  per  cent  of  those  showmg  no  evidence  of  rickets. 

Table  VIII. — Rickets,   by  age  and  sex;  children  under  2  years  of  age  given  physical 

examination.  ,  ,, 


Age  and  sex. 


ITotal 
ctuldren. 


With  rickets. 


Num- 
ber. 


Per 
cent. 


With  probable 
rickets. 


Without  rickets. 


Num- 
ber. 


Per 

cent. 


Num- 
ber. 


Per 
cent. 


Both  sexes. 


994 


5.3 


919 


92.5 


Under  6  months 

6  months,  under  1  year. 
1  year,  under  1 J  years . . 
IJ  years,  under  2  years.. 


Boys. 


Under  6  months 

6  months,  under  1  year. 
1  year,  under  IJ  years. . 
IJ  years,  under  2  years.. 


Girls. 


214 

278 
245 
257 

524 


1.4 
2.4 
4.7 


27 


113 
146 
128 
137 

470 


2.1 
3.1 
5.1 

1.7 


26 


1.1 

1.2 

18.3 

5.2 


1.4 

.8 
17.5 

5.5 


Under  6  months 

6  months,  under  1  j'ear. 
1  year,  under  IJ  years. . 
IJ  years,  under  2  years.. 


101 
132 
117 
120 


1.7 
4.2 


1.7 
19.2 


214  I 
271  I 
236  I 
198  [ 

483 


100.0 
97.5 
%.3 
77.0 

92.2 


113 
141 
123  I 
106 

436 


100.0 
96.6 
96.1 
77.4 

92.8 


101 
130 
113 
92 


100.0 
98.5 
96.6 
76.7 


Table  IX. — Rickets,   by  condition  of  tonsils;  children  under   2   years    of  age    given 

physical  examination. 


Condition  of  tonsils. 

Total 
children. 

With  rickets. 

With  probable 
rickets. 

Without  rickets. 

Nimi- 
ber. 

Per 

cent  .1 

Num- 
ber. 

Per 
cent.i 

Num- 
ber. 

Per 
cent.i 

Total 

994 

22 

2.2 

53 

5.3 

919 

92.5 

811 

1 

182 

180 

1 

16 

2.0  1            37 

4.6 

758 
1 

160 
158 

1 
1 

93.0 

6 
6 

3.3  i            16 
3.3  !            16 

8.8 
8.9 

87.9 

Enlarged  only 

87.8 

1 

'  Not  shown  where  base  is  less  than  50. 


Of  the  rachitic  children  10.7  per  cent  showed  "enlarged"  glands, 
38.7  per  cent  "palpable"  glands,  50.7  per  cent  nonpalpable  glands, 
as  compared  with  3.3  per  cent,  29.5  per  cent,  and  67.2  per  cent, 
respectivelj^,  of  the  nonrachitic  children. 


'  For  signs,  see  page  58. 
'  See  page  5S. 


EXAMINATION   OF   CHILDREN   UNDER  TWO   YEARS   OF  AGE. 


83 


Table  X. — Condition  of  glands,  by  presence  of  rickets;  children  under  2  years  of  age 

given  physical  examination. 


Condition  of  glands. 


Total 

Normal 

Palpable 

Enlarged  and  greatly  enlarged. . 

With  associated  infection 

Without  associated  infection 


Total 
children. 


Num- 
ber. 


656 
300 

38 
21 
17 


Per  cent 
distri- 
bution. 


100.0 


66.0 

30.2 

3.8 

2.1 

1.7 


With  rickets 

or  proballe 

rickets. 


Num- 
ber. 


Per  cent 
distri- 
bution. 


100.0 


50.7 

38.7 

10.7 

2.7 

8.0 


With 

With    prob- 

rick-  I   able 

ets.    I  rick- 

1    ets. 


Without  rickets. 


Num- 
ber. 


618 

271 

30 

19 

11 


Per  cent 
distri- 
bution. 


100.0 


67.2 

29.5 

3.3 

2.1 

1.2 


Bowlegs  were  more  common  among  the  boys  than  among  the 
girls,  13.7  of  the  boys  and  10.4  per  cent  of  the  ghls  bemg  thus 
deformed.  All  other  rachitic  signs  were  also  more  noticeable  in  the 
boys  than  in  the  girls. 

Arch  measurements. 

Arch  measurements  were  taken  on  552  infants  and  the  median 
height  was  found  to  be  the  same,  |  inch,  up  to  18  months,  but  increased 
to  f  inch  in  infants  from  18  months  to  2  j^ears. 

Mental  condition. 

Two  cases  of  apparent  and  five  cases  of  suspected  mental  defectives 
were  noted  during  the  course  of  the  study. 

Genitalia. 

A  very  large  per  cent  of  defects  of  genitalia,  chiefly  contracted  or 
adherent  prepuce,  was  found  among  boys — 71.4. 


A  summary  of  defects  found  in  children  under  2  years  of  age,  as 
compared  with  those  found  in  the  preschool  group,  is  here  given. 

Table  XI, — Comparison  of  the  prevalence  of  defects  in  children  under  2  years  of  age  and 
children  2  to  7  years  of  age  given  physical  examination. 


Summary  of  defects. » 


Children  under 
2  years  of  age. 


Number.   Per  cent 


Children  2  to 
7  years  of  age. 


Number.   Per  cent 


Total. 


Underweight  (10  per  cent  and  over) 

Anemia 

Head  defects 

Eye  diseases  and  defects  other  than  of  vision. 

Ear  defects  other  than  of  hearing 

Mouth  defects 

Naso-pharyngeal  defects 

Enlarged  glands 

Feart  defects 

Lung  defects 

Abnormal  skin  condition 

Abdominal  defects 

Bony  and  muscular  defects 


262 

22 

172 

23 

8 

26 

225 

38 

3 

9 

26 

150 

135 


100.0 


26.4 

2.2 

17.3 

2.3 

.8 

2.6 

22.6 

3.8 

.3 

.9 

2.6 

15.1 

13.6 


3,125 


303 

243 

163 

245 

25 

2,091 

2,157 

908 

99 

32 

318 

464 

1,308 


100.0 


9.7 

7.8 

5.2 

7.8 

.8 

66.9 

69.0 

29.1 

3.2 

1.0 

10.2 

14.8 

41.9 


1  For  specific  defects  see  Text  Table  II,  p.  29,  and  Appendix  Table  II,  p.  76. 


84 


PHYSICAL   STATUS   OF   PRESCHOOL   CHILDREN, 


Chart  V.  Per  cent  of  children  having  one  or  more  defects,  from  birth  to  G  years  of  age. 


Per  cent 
100 


80 


50 


30 


0 

Months 
Boys  . 
Girls  - 


^^ 

::::^ 

y'' 

x^ 

/ 
/ 

^ 

/ 
/ 
/ 
/ 
1 
1 
1 

1 
/ 

I 
1 
1 

1 

/ 
/ 
/ 
/ 
/ 
/ 
/ 

/ 
/ 
/ 
/ 
/ 
/ 

36 


60 


ADDITIONAL  COPIES 

OF  THIS  PUBLICATION  MAT  BE  PROCURED  FROM 

THE   SUPERINTENDENT  OF  DOCUMENTS 

GOVERNMENT  PRINTING  OFFICE 

■WASHINGTON,  D.  C. 

AT 

15  CENTS  PER  COPY 


V 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW 

AN  INITIAL  FINE  OF  25  CENTS 

WILL   BE  ASSESSED   FOR    FAILURE  TO   RETURN 
THIS    BOOK   ON   THE   DATE  DUE.    THE   PENALTY 
1             WILL  INCREASE  TO  50  CENTS  ON  THE  FOURTH 
DAY    AND    TO    $1.00    ON    THE    SEVENTH     DAY 
OVERDUE. 

-1  Wf^  ?i]^^^\[^^ 

^  fl^f]^^'"'^^ 

LD  21-100m-12,'43  (8796s) 

14  DAY  USE 

RETURN  TO  DESK  FROM  WHICH  BORROWED 

This  book  is  due  on  the  last  date  stamped  below,  or 

on  the  date  to  which  renewed. 

Renewed  books  are  subjert  to  immediate  recall. 

Tel.  No.  642-2511 

LD  21-32m-3,'74                               General  Library 
(R7057sl0)476 — A-32                     University  of  California 

Berkeley 

I 


U.C.  BERKELEY  LIBRARIES 


ca5T3flsa7i 


